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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical syndrome of hypertension, headache, palpitation, diaphoresis, flushing, and emotional lability is classically associated with pheochromocytoma. Two patients are presented with this constellation of symptoms in whom investigations for pheochromocytoma were unrevealing. Headache was the presenting and most prominent complaint, with daily episodes of short-lasting, intermittent, and paroxysmal attacks. Each paroxysm of headache was associated with a dramatic increase in systolic and diastolic blood pressure. After failure to control the labile fluctuations in blood pressure and headache with several classes of anti-hypertensive medications used in combination, a prompt and persistent response occurred after the administration of clonidine. The pathophysiology of this syndrome and the mechanism of clonidine action are reviewed in the context of a possible failure of the baroreceptor reflex.
Cephalalgia 2000 Jun
PMID:Recurrent short-lasting headache associated with paroxysmal hypertension: a clonidine-responsive syndrome. 1103 47

In a 25-year-old man, medullary thyroid carcinoma (probably a solitary sporadic form) was diagnosed following investigation of a small lump in the patient's neck. This was removed and followed up with further treatment. In a 27-year-old man, episodes of headache, palpitations and excessive perspiration (due to a pheochromocytoma) and a positive family history of thyroid problems led to further investigations and the subsequent diagnosis of multiple endocrine neoplasia (MEN) type 2A. The patient died at 48 years of age as the result of liver metastases. A total thyroidectomy had been carried out on a 19-year-old man with familial medullary thyroid carcinoma. The calcitonin levels remained elevated, but no tumour residues could be found. A 16-year-old girl with MEN type 2B had also previously undergone surgery. Her main complaint consisted of persistent constipation. Thyroid carcinomas usually present as a nodule in the neck. In 25% of cases, medullary thyroid carcinoma is part of the MEN2 syndrome. The clinical approach for medullary thyroid carcinoma is based on pathological findings following fine needle aspiration biopsy. The results of DNA tests determine the course of treatment and the need for family testing. In families with a hereditary form, there is a clear genotype-phenotype correlation. Early diagnosis and treatment can improve life expectancy.
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PMID:[Lump in the neck: 4 patients with a medullary thyroid carcinoma]. 1175 44

Pheochromocytoma is a tumor secreting catecholamines and is most often a sporadic and benign adrenal tumor. But in some cases the tumor is extra-adrenal (10%), malignant (10%) or familial (10%) and in this last case frequently bilateral. The clinical expression of pheochromocytoma is typically hypertension, with paroxysms including headache, excessive sweating, palpitations, but various clinical presentations can be observed. The biological diagnosis is represented by the measurement of urinary catecholamines. The most sensitive and specific test is the measurement of urinary metanephrines or of plasma methoxyamines. The tumor localization is generally easy using CT scan and (or) NMR imaging, associated with MIBG scintigraphy. The treatment is surgical after medical management.
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PMID:[Pheochromocytoma]. 1176 69

The pheochromocytoma is a medullo-adrenal tumor which develops at the cost of the chromaffin cells. It appears in 11-19% of cases of von Hippel-Lindau's disease (VHL), is often bilateral, and the symptomatology is often crude: arterial hypertension is frequently isolated and unstable, and the classic triad of headache, palpitations and sweating is quite rarely observed. We report four observations of bilateral pheochromocytomas in patients with von Hippel-Lindau's disease (three with phenotype IIA and one with phenotype IIB). The tumor was bilateral during the diagnosis in three cases; in the fourth patient, the attack on the contralateral adrenal gland came two years after the first adrenalectomy. All the patients had undergone an adrenalectomy by open surgery after a short preparation of 48 hours; replacement therapy was begun in each patient. Morbidity was low, and the patients submitted to a prolonged follow-up in order to screen for the onset of future lesions of VHL.
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PMID:[Bilateral adrenal pheochromocytomas in von Hippel-Lindau disease]. 1177 64

Pheochromocytoma, a relatively rare (<0.05% of hypertensives), catecholamine-secreting tumor, is almost always lethal unless recognized and appropriately treated. Clinical and biochemical manifestations are mainly caused by excess circulating catecholamines and hypertension. Manifestations mimic many conditions, which may result in erroneous diagnoses and improper treatment. Sustained or paroxysmal hypertension associated with headaches, sweating, or palpitations, occurs in 95% of patients, but at least 5% are normotensive. All patients with manifestations of hypercatecholaminemia or coexisting neoplasms should be investigated for pheochromocytoma. Plasma free metanephrines and fractionated urinary metanephrines are the most sensitive (about 100%) chemical tests for diagnosing sporadic and familial pheochromocytomas; plasma and urinary catecholamines and total metanephrines are fairly sensitive for identifying sporadic cases but are less sensitive for familial tumors. The clonidine suppression test helps exclude other conditions that may elevate plasma and urinary catecholamines and their metabolites. Magnetic resonance imaging is more sensitive than computed tomography for localizing pheochromocytomas; iodine-131-metaiodobenzylguanidine (131I-MIBG) tumor uptake confers specificity. Surgical resection is successful in 90% of cases, but 10% of tumors are malignant. Pheochromocytomas <5 cm in diameter can be removed laparoscopically; larger tumors should be removed by open surgery. Drug treatment prior to and during surgery is mandatory; drug treatment, chemotherapy, and radiation therapy are used to treat malignant lesions.
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PMID:Pheochromocytoma. 1182 44

A 35-year-old woman was admitted to our hospital with the following complaints, headache, sweating, anxiety, dizziness, nausea, vomiting and severe hypertension. The technical images (abdominal CT, scintigraphic octreotide scan and renal arteriography) revealed the presence of a left adrenal pheochromocytoma and stenosis of the renal artery. Ten days following adrenalectomy, watery diarrhea appeared. The long-acting somatostatin analogue octreotide (LAR, 30 mg/month, i.m.), was started, and after 2 weeks diarrhea decreased and gradually disappeared. In conclusion, we were confronted with an unusual case of pheochromocytoma associated with renal artery stenosis and the appearance of watery diarrhea some days after surgical treatment. Treatment with octreotide brought about the remission of diarrhea in this patient.
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PMID:A case of pheochromocytoma with renal artery stenosis and post-surgical watery diarrhea. 1184 76

A case of 34-year old female with incidentally diagnosed adrenal tumour is discussed. The patient complained only of mild headaches and heart palpitations and was not previously treated for hypertension. A diagnosis of pheochromocytoma was made. The diagnostic controversies arose because of subclinical course of the disease, slightly elevated biochemical markers of pheochromocytoma (catecholemines urinary excretion) and non-characteristic result of glucagon stimulation test results. The diagnosis was confirmed by histologic examination of tumour tissue. Presented case indicates the need for thorough clinical and hormonal evaluation of patients with incidentaloma (particularly, when adrenal tumour diameter is larger than 3 cm) to avoid serious complication of surgery treatment in case of misdiagnosis.
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PMID:[An oligosymptomatic case of pheochromocytoma]. 1186 92

A 25-year-old male student complained about episodic palpitations, dizziness, nausea and headache 5 years prior to presentation. No otorhinolaryngic, neurologic or gastrointestinal causes were identified. Several ECG recordings revealed sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm. The patient was given a permanent DDD-pacemaker. Six months later, the clinical symptoms were unchanged. During an attack, physical examination revealed paleness, diffuse sweating and an arterial blood pressure of 250/130 mmHg, which decreased to 120/80 mmHg within a few minutes. Abdominal ultrasound and abdominal computed tomographic scan demonstrated the presence of a large (6.4 x 5.5 cm) left-sided adrenal mass. Two 24-h-urinary collections demonstrated elevated noradrenaline (mean 315 micrograms/24 h, normal < 80 micrograms/24 h) and adrenaline (mean 268 micrograms/24 h, normal < 20 mg/24 h) levels. Blood samples, which were drawn during excessive blood pressure rise, revealed elevation of plasma catecholamines (6.793 pg/ml for adrenaline (normal 50-150 pg/ml) and 10.424 pg/ml for noradrenaline (normal 200-500 pg/ml), so that the diagnosis of pheochromocytoma was considered established. The tumor was successfully removed during laparascopic surgery. After surgery, the patient remained well and normotensive. Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. This case underlines that sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm is a potential early manifestation of a pheochromocytoma. These changes seem to disappear after successful removal of the tumor.
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PMID:[Sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm as initial manifestation of pheochromocytoma]. 1196 12

Severe sustained hypertension occurs in only 0.1% of the pediatric population and only about 2% of these patients will have an underlying endocrine cause. Pheochromocytoma as a catecholamine secreting tumour causing severe hypertension is exceedingly rare in children. A high index of suspicion and an awareness of the clinical spectrum are therefore necessary to make the diagnosis. We report two cases of pheochromocytoma occurring in two a 12 year-old boys who's presented with sustained hypertension, headache, sweating, and visual blurring. Measurement of 24 hour urinary catecholamines showed a marked increase and localization of adrenal unilateral pheochromocytoma was determined by ultrasonography and computed tomography. The approaches to the adrenal gland were transverse transperitoneal and the excision of the tumors was followed of return to the normal of tensional numbers.
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PMID:[Pheochromocytoma in children. Two case reports]. 1196 54

Phaeochromocytoma is a rare but important cause of secondary hypertension that can prove fatal when undiagnosed. Several autopsy studies have reported that a large number of undiagnosed tumours occur during life. This review discusses the diagnostic guidelines for phaeochromocytoma. Factors such as hypertension, sustained or paroxysmal, in association with the most common symptoms of headache, sweating and palpitations, can be used to provide a suspicion of phaeochromocytoma. Although measures of plasma methoxylated catecholamines may provide a promising diagnostic method, the cornerstone for diagnosing phaeochromocytoma remains 24 h or overnight sampling of urinary free catecholamines and methoxylated catecholamines.
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PMID:[Pheochromocytoma--rare and often undiagnosed condition]. 1202 14


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