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EXPLAINING A CONFUSING SURGERY

Q: After many tests to discover the cause of a difficult-to-manage high blood pressure condition, a diagnosis of pheochromocytoma has been made, and my husband now faces surgery. But we are anxious and confused. A: Let me see if I can tell you some things that your physician may have overlooked to clear up some of the confusion. Broken down to its Greek origins, pheochromocytoma means dusky (pheo) colored (chromo) cell (cyt) tumor (oma), and it is in fact a tumor of chromaffin cells that secrete chemicals called catecholamines.

These chemicals produce a number of reactions in the body. Typically a patient will experience episodic sweating, headaches and palpitations and will be found to have an elevated blood pressure when tested. Additional symptoms of flushing, abdominal pain, constipation, shortness of breath, nausea and vomiting may occur.

At first the symptoms come on infrequently and last for 15 minutes or so, but with passing time, both the severity and frequency of the attacks increase.

Although the physical examination may be normal, a urine test will show an increased level of catecholamines. Testing a 24-hour urine specimen for various other chemicals that result from the chemical breakdown of catecholamines will usually lead to an accurate diagnosis.

The next problem is to determine the location of the tumors. They average 5 to 6 cm in size and usually weigh from 50 to 200 gm, but can grow as large as several kilograms. About 80 percent of the time they are found in the adrenal gland, which perches on the kidney. However, they may be found in glands on both sides of the body (in about 10 percent of the cases) and may be located in other areas of the body as well.

A variety of imaging techniques such as computed tomography and magnetic resonance imaging are used to complement scintigraphy, which uses radioactive isotopes to locate the tumors.

Surgery is needed to permanently remove the tumors, and the patient must endure a period of treatment when various medications are used to assure that the hypertension and other symptoms are controlled before the operation is performed.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

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