Pheochromocytoma - Medical Malpractice Lawyers

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Pheochromocytoma - Medical Malpractice

Pheochromocytomas are a type of noncancerous tumour that release high amounts of norepinephrine and epinephrine into the blood stream. They are located within the adrenal glands, which lie atop the kidneys. The adrenal glands have two sections, the medulla and the cortex. The cortex secretes cortisol and other cortisol-related hormones and the medulla secretes epinephrine and norepinephrine. The adrenal gland also secretes aldosterone, which controls water and salt regulation.

Pheochromocytomas can occur at any age. About ten percent occur in children and the peak age is in the twenties through forties. Pheochromocytomas are relatively rare, with about 800 occurring in the US each year. Ninety percent of these are completely benign while 10 percent are cancerous.

The symptoms of pheochromocytoma include a headache, palpitations and sweating of the body. Blood pressure is quite high and you can get nausea, weight loss, anxiety, tremors, weakness and abdominal pain. Some people actually have no symptoms and about ten percent of pheochromocytomas are incidentally found. The blood pressure problem can be confusing and can come and go. Only about 0.2 percent of people with high blood pressure will have a pheochromocytoma as a cause of their high blood pressure.

Pheochromocytomas can be a part of multiple endocrine neoplasia or MEN-2A and 2B. These are genetic syndromes that are associated with other endocrine problems. They are associated with an autosomal dominant genetic condition. Von Hippel-Lindau syndrome and neurofibromatosis are associated with pheochromocytomas. There can be sporadic cases of the condition that are not found to be hereditary.

Any disease that can cause over activity of the sympathetic nervous system can mimic a pheochromocytoma. These can include taking too many decongestant medications, being anxious or having a panic attack, stopping high blood pressure medications, or having spinal cord injuries.

The diagnosis of pheochromocytoma is important because it can lead to serious consequences if not identified and treated. The physician must be suspicious of the disease because of the signs and symptoms he or she finds. The family history must be taken into account. Then, the doctor must do tests of catecholamines and metanephrines must be measured in a 24 hour urine collection. Metanephrines can be evaluated in the blood. If these are greater than twice the normal level, then imaging studies are done. This includes an MRI exam or a CT exam of the gland which can show a mass in the adrenal gland in the medulla, which is the deepest part of the adrenal gland. Radioactive dye can be put into the system which can shine up the tumour in the gland. Ultrasound may or may not be helpful.

The definitive treatment of a pheochromocytoma is surgical excision of the tumour. Until the tumour is removed, the doctor must control the blood pressure as best as possible. If surgery is required, an acute hypertensive crisis can occur so this must be controlled before surgery can be undertaken. Treatment with medication includes beta blockers and alpha blockers, which act directly to control catecholamine induced hypertension. They are also used in the operating room to prevent Intraoperative hypertension. The medications must be blocked around 7-10 days postoperatively to control the blood pressure before the surgery. The beta blocker is used after the alpha blocker is given maximally. You need an experienced surgeon and an experienced anaesthesiologist in order to successfully go through surgery without complication. Surgery requires intense blood pressure monitoring with an arterial line and a Swan Ganz catheter. Stress doses of steroids may need to be given if both adrenal glands need surgery. Laparoscopic surgery can be done if the tumour is less than 8 centimetres in diameter.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here