Symptoms of Pheochromocytoma, With Particular Reference to Headache, Correlated With Catecholamine Production

Abstract

In a series of 27 patients with proved pheochromocytoma, differential analysis of catecholamines in blood, urine, and tumor specimens of 19 patients enabled grouping of subjects into those whose tumors produced predominantly norepinephrine (NE) (11 patients), predominantly epinephrine (E [Two patients]) and approximately equal amounts of both (six patients). Sustained hypertension was more common in the first group and pallor and tremor in the latter two groups, but no distinctive syndrome could be recognized as signifying the secretion of NE or E. Headache was a symptom in 20 of 27 patients and was related to sudden, transient elevation of the blood pressure, rather than sustained hypertension. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines, which respectively enhance and diminish vascular headache.

Cefaléia em pacientes com feocromocitoma: influência da hipertensão arterial

“…Alguns pacientes mesmo na vigência da hipertensão arterial não referem cefaléia [1][2][3] . Estes achados sugerem, no mínimo, que a presença de hipertensão arterial não é o único elemento necessário para o aparecimento das cefaléias.…”

“…Elas são caracterizadas por: duração média de segundos até horas; frequência de uma a três vezes ao dia; localização bilateral frontal com irradiação temporal ou, mais raramente, unilateral e occipital; taquicardia e sudorese antecedendo os quadros álgicos; palidez e elevação da pressão arterial acompanhando as crises de cefaléia. Atividades físicas, posição supina, manobras de Valsalva, retirada do tumor são considerados, respectivamente, como fatores desencadeantes, de piora e de melhora clínica [1][2][3][4][5] .…”

Headache in Pheochromocytoma

“…(4) The headache is generally described as throbbing, pulsating, or bursting in quality, and is moderately to very severe in intensity. (8) As in the other patients with pheochromocytoma, headaches are frequently associated with palpitation and perspiration. Other features include apprehension and/or anxiety, often with a sense of impending death, tremor, visual disturbances, abdominal or chest pain, nausea, vomiting, and occasionally paraesthesia.…”

“…(4) However, in patients with migraine, it may last longer. (8) The headache was nearly always bilateral, (8) affecting any part of the head. The occipital, nuchal-occipital, and frontal-occipital regions are the predominant locations.…”

“…(4)(5)(6)(7) Second, it is frequently the presenting symptom. (8) Third, it may be the only symptom. (9)(10) Fourth, it may be the presenting symptom of a life-threatening disease with a histopathologically confirmed tumor.…”