What is it?

A catecholamine-secreting tumor that is located within or on the outside of the adrenal gland.  About 90 % of tumors are located within the adrenal medulla.  Only 10 % of cases will have bilateral tumors (on both adrenal glands). If a tumor is present on both adrenal glands, genetic disorders such as MEN (Multiple Endocrine Neoplasia) and neurofibromatosis should be ruled out.

Let’s talk Catecholamines

Catecholamines are hormones that trigger the sympathetic system “fight or flight” response. Phenylalinine is the precursor to tyrosine, the amino acid that produces the dopamine.

Pathway of production:

Phenylalinine–> Tyrosine–>L-dopamine–>dopamine–> norepinephrine–>epinephrine

Tyrosine can be supplied via diet or supplementation. Dietary sources include turkey, chicken, milk, cheese, bananas, and yogurt.

Fun fact: Did you know that your thyroid hormones (T3 and T4) are derived from tyrosine?

What are typical signs and symptoms?

• Sudden or severe hypertension
• Tachycardia
• Constipation
• Nausea
• Vomiting
• Cold skin
• Sweating
• Angina
• Possible weight loss

Each person may experience a different combination of the symptoms listed above. There are several conditions that will have the same combination of signs and symptoms therefore proper lab and imaging is very important.

Granted, a pheochromocytoma is the cause of 1/1000 hypertensive patients yet that 1 person could be you or a loved one.

What labs do you run?

• Serum Metanephrine: Levels will be continuously elevated unlike intermittent increases of other catecholamines.

• 24 hour urine (metanephrine, catecholamines, cortisol): Vanillymandelic acid (VMA) and homovanillic acid (HVA) are urine markers. VMA and HVA are rarely high in an a healthy person

Imaging

• Chest and abdomen CT and MRI with and without contrast.

How is it treated?

• 1st choice: Surgical removal of tumor. Laproscopic surgery is available, in most cases.
Don’t worry, it is possible to function with one adrenal gland
• Beta blockers in combination with alpha blockers to help control blood pressure
This is important to control blood pressure before surgery

From a naturopathic perspective, discovering the root cause is very important. In the case of a severe hypertensive patient, whether continuous or intermittent, a pheochromocytoma is a likely differential diagnosis. If the tumor causes more damage than good, it may be best to remove the tumor than try to shrink or eliminate it.

Before you start throwing tomatoes, there are always exceptions to this rule and a consult with your physician is vital.

Feel free to share your thoughts, comments, and questions below!