Editing Adrenal: Pheochromocytoma (section)

=== History and Physical Exam ===

* '''<span style="color:#ff0000">History'''
** '''<span style="color:#ff0000">Signs and Symptoms'''
*** '''<span style="color:#ff0000">Classic triad (3):'''
***# '''<span style="color:#ff0000">Headache'''
***# '''<span style="color:#ff0000">Episodic sudden perspiration'''
***# '''<span style="color:#ff0000">Tachycardia'''
*** '''<span style="color:#ff0000">Other symptoms (12):[https://pubmed.ncbi.nlm.nih.gov/10096149/ §]'''
***#'''<span style="color:#ff0000">Anxiety'''
***#'''<span style="color:#ff0000">Sweating'''
***#'''<span style="color:#ff0000">Palpitations'''
***#'''<span style="color:#ff0000">Abdominal pain'''
***#'''<span style="color:#ff0000">Chest pain'''
***#'''<span style="color:#ff0000">Pallor'''
***#'''<span style="color:#ff0000">Nausea'''
***#'''<span style="color:#ff0000">Dyspnea'''
***#'''<span style="color:#ff0000">Tremor'''
***#'''<span style="color:#ff0000">Weight loss'''
***#'''<span style="color:#ff0000">Flushing'''
***#'''<span style="color:#ff0000">Visual disturbance'''
***'''Can have heterogenous clinical behavior due to the variability in the amount and ratio of the different catecholamines (norepinephrine, epinephrine, dopamine)''' '''secreted:'''
**** '''Norepinephrine-predominant tumours''' (e.g., patients with von Hippel- Lindau [VHL] syndrome) '''have hypertension and sweating because of norepinephrine's vasoconstricting action through the α adrenoreceptor'''
**** '''Epinephrine-predominant tumours (rare, usually limited to adrenals or the organ of Zuckerkandl)''' '''have syncope or hypotensive episodes because of epinephrine’s vasodilatory action through the β2 receptor'''
**** Agonist potency order:
***** '''α1: epinephrine ≥ norepinephrine''' >> isoprenaline
***** '''α2: epinephrine ≥ norepinephrine''' >> isoprenaline
***** β1: isoprenaline > epinephrine = norepinephrine
***** '''β2:''' isoprenaline > '''epinephrine >> norepinephrine'''
***** β3: isoprenaline = norepinephrine > epinephrine
*** Episodic hypertensive episodes may be triggered by events such as induction of anesthesia, labor and delivery, instrumentation and biopsy of the tumor, strenuous physical activity and consumption of tyramine rich foods, such as red wine, chocolate and cheeses.
*** Another serious clinical presentation may result from catecholamine induced cardiomyopathy when patients present with congestive heart failure and cardiac arrhythmias.