Pheochromocytoma physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
Common physical exam findings include:
 
*[[Tachycardia]]
=== Appearance of the Patient ===
*[[Hypertension]], including paroxysmal (sporadic, episodic) high blood pressure, which sometimes can be more difficult to detect.
 
*[[Orthostatic hypotension]]
=== Vital Signs ===
* [[Tachycardia]] with regular pulse. Irregular pulse occurs in supraventricular tachycardia.
* Tachypnea / bradypnea if malignant secondaries found in lung
* Rapid strong equal pulse
* High blood pressure with normal pulse pressure
* Hypotension occurs due to fluid contraction
 
=== Skin ===
* [[Jaundice]] if liver malignant secondaries affected liver functions.
 
=== Head ===
* Abnormalities of the head may include:
* Facial flushing
* Scleral icterus if liver malignant secondaries affected liver functions.
* MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas.
 
=== Neck ===
* [[Jugular venous distension]]
* [[Lymphadenopathy]] if malignant secondaries found in neck (firm , rapid increase in size of the node and painless)
* [[Thyromegaly]] / thyroid nodules if MEN patient associated with medullary thyroid malignancy<ref name="pmid258100472">{{cite journal| author=Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF et al.| title=Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. | journal=Thyroid | year= 2015 | volume= 25 | issue= 6 | pages= 567-610 | pmid=25810047 | doi=10.1089/thy.2014.0335 | pmc=4490627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25810047  }}</ref>
 
=== Lungs ===
* Asymmetric chest expansion / Decreased chest expansion if malignant lung secondaries are found in lung
 
=== Heart ===
* Chest tenderness upon palpation in MEN1 patients associated with hyperparathyroidism
* Palpation: Pericordial heave especially at apex due to left ventricular hypertrophy in long standing patients
* Auscultation: normal s1 and accentuated s2 due to high systemic resistance.
 
=== Abdomen ===
* [[Abdominal distention]] in patients with primary hyperparathyroidism associated constioation or hirschsprung disease
* [[Abdominal tenderness]] in the lower abdominal quadrants in MEN2 patients with hirschsprung disease<ref name="pmid7491537">{{cite journal| author=O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA| title=Multiple endocrine neoplasia type 2B: more than an endocrine disorder. | journal=Surgery | year= 1995 | volume= 118 | issue= 6 | pages= 936-42 | pmid=7491537 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7491537  }}</ref>
* A palpable abdominal mass in the lower abdominal quadrant
* Guarding may be present
* [[Hepatomegaly]] if malignant secondaries found in liver
* Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.<ref name="pmid25810047">{{cite journal| author=Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF et al.| title=Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. | journal=Thyroid | year= 2015 | volume= 25 | issue= 6 | pages= 567-610 | pmid=25810047 | doi=10.1089/thy.2014.0335 | pmc=4490627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25810047  }}</ref>
 
=== Back ===
* Point tenderness in MEN1 patients with hyperparathyroidism


==References==
==References==

Revision as of 14:31, 10 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Common physical exam findings of pheochromocytoma include tachycardia, hypertension, and orthostatic hypotension.

Physical Examination

Appearance of the Patient

Vital Signs

  • Tachycardia with regular pulse. Irregular pulse occurs in supraventricular tachycardia.
  • Tachypnea / bradypnea if malignant secondaries found in lung
  • Rapid strong equal pulse
  • High blood pressure with normal pulse pressure
  • Hypotension occurs due to fluid contraction

Skin

  • Jaundice if liver malignant secondaries affected liver functions.

Head

  • Abnormalities of the head may include:
  • Facial flushing
  • Scleral icterus if liver malignant secondaries affected liver functions.
  • MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas.

Neck

Lungs

  • Asymmetric chest expansion / Decreased chest expansion if malignant lung secondaries are found in lung

Heart

  • Chest tenderness upon palpation in MEN1 patients associated with hyperparathyroidism
  • Palpation: Pericordial heave especially at apex due to left ventricular hypertrophy in long standing patients
  • Auscultation: normal s1 and accentuated s2 due to high systemic resistance.

Abdomen

  • Abdominal distention in patients with primary hyperparathyroidism associated constioation or hirschsprung disease
  • Abdominal tenderness in the lower abdominal quadrants in MEN2 patients with hirschsprung disease[2]
  • A palpable abdominal mass in the lower abdominal quadrant
  • Guarding may be present
  • Hepatomegaly if malignant secondaries found in liver
  • Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.[3]

Back

  • Point tenderness in MEN1 patients with hyperparathyroidism

References

  1. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.
  2. O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA (1995). "Multiple endocrine neoplasia type 2B: more than an endocrine disorder". Surgery. 118 (6): 936–42. PMID 7491537.
  3. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.


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