Clinical Features and Presentation
The presenting features of phaeochromocytoma are very wide and varied. For this reason it is referred to as the great mimic.
Differential diagnosis of Phaeochromocytoma [6,8].
Endocrine
- Hyperthyroidism
- Carcinoid
- Hypoglycaemia
- Medullary thyroid carcinoma
- Mastocytosis
- Menopausal syndrome
Cardiovascular
- Heart failure
- Arrythmias
- Ischaemic heart disease
- Baroreflex failure
- Renovascular hypertension
Neurological
- Migraine
- Stroke
- Diencephalic epilepsia
- Meningioma
- Postural orthostatic tachycardia syndrome
Miscellaneous
- Essential hypertension
- Alcohol withdrawal
- Pre-eclampsia
- Porphyria
- Panic disorder or anxiety
- Factitious disorders
- Drug treatment
- Illegal drug use
Hypertension is a common presenting feature with systolic BP >220 mmHg or diastolic above 120 mmHg being generally accepted limiting values. Hypertension is frequently associated with profound tachycardia, pallor and a feeling of anxiety or impending doom [9]. These symptoms are often paroxysmal and can occur many times a month or just once with a single fatal presentation.
Precipitants can include abdominal compression, anaesthesia, opiates, dopamine antagonists, cold medications, radiographic contrast media, catecholamine reuptake inhibitors and childbirth [6,9].