Pheochromocytoma physical examination
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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
- 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[1]
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
- ↑ 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.
- ↑ 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.
- ↑ 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.