endocrine and metabolic disorders
Pheochromocytoma
Symptoms and Signs of Pheochromocytoma
 Hypertension , which is paroxysmal in 45% of patients, is prominent. About 1/1000 hypertensive patients has a pheochromocytoma. Common symptoms and signs are Tachycardia Diaphoresis Postural hypotension Tachypnea Cold and clammy skin Severe headache Angina Palpitations Nausea and vomiting Epigastric pain Visual disturbances Dyspnea Paresthesias Constipation A sense of impending doom Paroxysmal attacks may be provoked by palpation of the tumor, postural changes, abdominal compression or massage, induction of anesthesia, emotional trauma, unopposed beta-blockade (which paradoxically increases blood pressure by blocking beta-mediated vasodilation), or micturition (if the tumor is in the bladder). In older patients, severe weight loss with persistent hypertension is suggestive of pheochromocytoma. Physical examination, except for the presence of hypertension, is usually normal unless done during a paroxysmal attack. Retinopathy and cardiomegaly are often less severe than might be expected for the degree of hypertension, but a specific catecholamine cardiomyopathy can occur. However, cardiac and cerebrovascular events are more frequent in patients with pheochromocytomas than in others with similar blood-pressure levels. 