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Treatment for Pheochromocytoma - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
Doctor :   hi
User :   hello
Doctor :   How can I help you ?
User :   i have been feeling ill lately, been taking some reflux medication that didnt cure my sypmtoms recently an ultrasound shows a 1 cm z 2 cm mhypodense kidney mass on lefy kidney .. my blood test said slightly elevated rbc and higher bilirubin in the mornings i feel nauseated and herave could the bilirubin or rbc count make me feel diahrea and nausea in morning?
Doctor :   Ok, I have seen your query.
Doctor :   May I ask you a few questions to help you better ?
User :   ok
Doctor :   May I know your age and gender ?
User :   55 male
Doctor :   May I know if you are mentioning about GERD by REFLUX ?
User :   that was the original idea before but the medication is not totaly effective still feel sick when i awake
Doctor :   May I know what medication you are on and since how long ?
User :   ytied tagamet and a ppi for a while iy was ok but did not stop it totally
Doctor :   Ok
User :   could the kidney or blood test be cause of sypmyoms?
Doctor :   No, they are totally different issues , I mean the kidney mass and the RBC Count and the nausea or diarrhoea.
Doctor :   But the Serum Bilirubin , if it shoots up may cause nausea for sure .
User :   the doctor said something on the kidney would invrease a hormone and cause the rbc to rise but that wouldnt make me feel nausea?
Doctor :   What was the radiologist's comment on the ultrasound scan report ?
Doctor :   Yes, that is the adrenals , called phaechromocytoma .
User :   hpodense kidney mass 1cm x 2cm x 2 cm ... color doppler flow around the periphery recommedning a ct scan
Doctor :   And they would cause RBC to rise , but no vomiting, nausea .
Doctor :   He is right .
User :   ok is this a cyst?
Doctor :   Ok, A CT Scan would be a confirmatory diagnossis for it .
User :   its hard to tell on ultrasound?
Doctor :   No they are hyperactive adrenal glands which are present in every individual , but in some they over perform , causing some issues .
Doctor :   How is your blood pressure ?
User :   140 x 80 i am overweight
Doctor :   As it is the commonest symptom of this problem ?
Doctor :   Ok.
Doctor :   May I know your weight ?
User :   doctor said when he sees ct scan he may refer me to urologist -- mentioned surgery isnt it too early to tell that???
User :   240 lbs
Doctor :   Ok.It might be too early, Could you let me know if he asked for the above symptoms : Doctor :   Someone with a pheochromocytoma usually has three classic symptoms -- headache, sweating, and heart palpitations (a fast heart beat) in association with markedly elevated blood pressure (hypertension). Other conditions that may accompany these classic symptoms are as follows: anxiety, nausea, tremors, weakness, abdominal pain, and weight loss.
User :   no i dont have those symptoms
User :   ok im sorry i do feel anxiety abdominal painn i do
User :   weught gain not loss
Doctor :   Ok, So that shows up that it may not be the cause and is totaly unrelated.
Doctor :   Ok, Before the CT, I would advise you to undergo some more tests to rule out this problem : Doctor :   First, hormones such as catecholamines and metanephrines are measured in a 24 hour urine collection, and metanephrines may also be measured in the blood. If these are greater than 2 times the normal level, imaging studies are usually done to look at the adrenal glands
Doctor :   Hope you have followed ?
User :   is that the kidney mass causing this?
Doctor :   Are you asking - Is it causing Reflux ?
User :   no the nausea and anxiety
Doctor :   Ok, Nausea and anxiety can be caused by that very much.
User :   what is the name of this condition?
Doctor :   pheochromocytoma .
User :   is it caused by the kidney mass or a different thing?
Doctor :   It is caused by a mass on the kidney almost like a cap, called adrenal, in ultrasound difficult to differentiate.
User :   so how do i describe this to the doctor? it is on th pole of the kidney
Doctor :   Yes, North pole .
Doctor :   I want you to discuss the following points : Doctor :   If it is what he is suspecting then ask him to get a blood test done before CT/MRI
Doctor :   1. Blood test for Hormones
Doctor :   2. If they are 2 times high then normal
Doctor :   then 3. CT Scan
User :   ok i asked for a copy of bloodwork we did yesterday which items should i ve looking vor?
User :   what are the hormone tests called?
Doctor :   S.catecholamines and S.metanephrines
User :   thank you
User :   if those are high this is causing me these symptoms correct?
Doctor :   For the reflux do you want to discuss anything else ?
Doctor :   Yes absolutely right.
User :   no i think its not reflux because it hasnr cured me .. the doctor said if its not working to stop taking
User :   is cure for this to remove the mass or is there other treatment?
Doctor :   Ok.Surgery is the definitive treatment. Until the tumor is removed, control of blood pressure is a top priority. Controlling blood pressure before and during surgery is the trickiest part of care. There is a chance of developing an acute hypertensive crisis after anesthesia is given during the surgery. The blood pressure is therefore closely monitored through the procedure. Consultation with an endocrinologist is recommended to help design treatment for individual patients.
User :   is it a cyst?
Doctor :   No it might be , but can definitely diagnose only aftre we run through the blood work
User :   is this a benign tumor?
Doctor :   Phaeochrmocytoma is not cyst
Doctor :   but the mass can be
User :   so will the ct scan confirm this?
Doctor :   Yes , it would definitively.
User :   ok i am getting a report on bloodwork and will check back
User :   what can i take to control the nausea and dry heaving?
Doctor :   Please take a 10 mg of Domperidone , it is an OTC Drug. twice daily temporarily.
User :   thank you
Doctor :   Thank you for ocnsulting me
User :   i will send reports thank you
Doctor :   Wish you all the best in your blood work and CT.
Doctor :   Take care.
Doctor :   Bye for now.
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