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Suggest Treatment For Hypertension And Palpitations
Question:
Patient Profile
Gender: Female
Age: 57
Visited a Doctor: Yes
Medications Tried: My BP was going as high as 280/140 with activity and then quickly returning to normal 110/70. I was started on Cartia, Cardura and HCTZ.
I had a 24 hour urine done because of hypertension, palpitations and headache. The levels for norepinephrine, normetanephrine came back 3 times the upper limit of normal. VMA was 2 times the upper limit of normal and Dopamine was moderately elevated.Today I had an MRI which was normal and a Thyroid US that showed an 8mm indeterminate solid nodule Thyroid and an adjacent complex cyst. The radiologist that read the MRI recommended a MIBG scan.
The workup was to rule out a pheochromocytoma. Could the MRI miss finding a pheochromoytoma? What would the MIBG scan show that an MRI wouldn't? Is the thyroid nodule and cyst of any significance?
Patient Profile
Gender: Female
Age: 57
Visited a Doctor: Yes
Medications Tried: My BP was going as high as 280/140 with activity and then quickly returning to normal 110/70. I was started on Cartia, Cardura and HCTZ.
I had a 24 hour urine done because of hypertension, palpitations and headache. The levels for norepinephrine, normetanephrine came back 3 times the upper limit of normal. VMA was 2 times the upper limit of normal and Dopamine was moderately elevated.Today I had an MRI which was normal and a Thyroid US that showed an 8mm indeterminate solid nodule Thyroid and an adjacent complex cyst. The radiologist that read the MRI recommended a MIBG scan.
The workup was to rule out a pheochromocytoma. Could the MRI miss finding a pheochromoytoma? What would the MIBG scan show that an MRI wouldn't? Is the thyroid nodule and cyst of any significance?
Brief Answer:
Better to go for MIBG scan
Detailed Answer:
Hello welcome to HCM.
I have read your question and understand your concerns.
Pheochromocytomas are adrenal gland tumour which are potentially curable but dangerous if not removed as it causes extremes of blood pressure.
My advice to you is -
1. Usually MRI is more than 95% sensitive in detecting small adrenal gland tumours but as it has failed unfortunately in your case we have to go for MIBG scan, there is no other option.
Your blood reports of adrenaline, metanephrines are significantly high to search for occult tumour which is responsible for this. SO, BEYOND DOUBT GO FOR MIBG SCAN.
(MIBG scan will help in localisation of tumours because it's interaction with noradrenaline - explanation of this is at present beyond our discussion)
2.The other important thing is that Pheochromocytomas can be a part of MULTIPLE ENDOCRINAL NEOPLASIA 2(MEN 2) Syndrome. Which is usually associated with thyroid carcinoma and rarely parathyroid tumours. So, as you have been found on sonography thyroid cyst or nodule-Kindly ask your doctor regarding my advice. You might required thyroid scan or MRI thyroid to rule out tumour.
3.The treatment of choice in pheochromocytoma is SURGICAL RESECTION of tumour. After treatment usually patients have complete cure from hypertension. So, I wish that your tumour has been detected early and you will have successful resection! Till then continue medical therapy which have been prescribed to you.
Thank you.
I hope I have given you satisfactory answer. You are welcome always if you have any other questions.
Have a nice day.
Better to go for MIBG scan
Detailed Answer:
Hello welcome to HCM.
I have read your question and understand your concerns.
Pheochromocytomas are adrenal gland tumour which are potentially curable but dangerous if not removed as it causes extremes of blood pressure.
My advice to you is -
1. Usually MRI is more than 95% sensitive in detecting small adrenal gland tumours but as it has failed unfortunately in your case we have to go for MIBG scan, there is no other option.
Your blood reports of adrenaline, metanephrines are significantly high to search for occult tumour which is responsible for this. SO, BEYOND DOUBT GO FOR MIBG SCAN.
(MIBG scan will help in localisation of tumours because it's interaction with noradrenaline - explanation of this is at present beyond our discussion)
2.The other important thing is that Pheochromocytomas can be a part of MULTIPLE ENDOCRINAL NEOPLASIA 2(MEN 2) Syndrome. Which is usually associated with thyroid carcinoma and rarely parathyroid tumours. So, as you have been found on sonography thyroid cyst or nodule-Kindly ask your doctor regarding my advice. You might required thyroid scan or MRI thyroid to rule out tumour.
3.The treatment of choice in pheochromocytoma is SURGICAL RESECTION of tumour. After treatment usually patients have complete cure from hypertension. So, I wish that your tumour has been detected early and you will have successful resection! Till then continue medical therapy which have been prescribed to you.
Thank you.
I hope I have given you satisfactory answer. You are welcome always if you have any other questions.
Have a nice day.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you so much for your detailed answer. I forgot to mention that my 28 year old daughter was diagnosed with Renal Cell Cancer 6 months ago and had a partial nephrectomy. My 87 year old father has an adrenal mass that has been followed for years without surgery. Do you think this could be related to my symptoms?
Thanks so much. XXXXXXX
Thanks so much. XXXXXXX
Brief Answer:
Kindly read my detailed answer
Detailed Answer:
Hello welcome back again.
I have read your question about familial history of tumours.
My advice to you is -
1. Actually without seeing all your reports and your daughter's, it is very difficult to say which disease is going on in family. But my advice is there is definitely strong family history and you should go for gebetical analysis.
Take also opinion of endocrinologist and oncologist regarding this. You will definitely get your answer.
2.There are some familial syndromes which can cause pheochromocytoma and Renal cell tumour.
I will give examexample of one -
Von hipple XXXXXXX syndrome (VHL)
But we cannot discuss much online.
At least I can guide you as an MD that you should go for further analysis at least for your children and grand children.
I hope I have given you satisfactory answer, if you feel the same Kindly rate the answer.
Thank you.
Have a nice day.
Kindly read my detailed answer
Detailed Answer:
Hello welcome back again.
I have read your question about familial history of tumours.
My advice to you is -
1. Actually without seeing all your reports and your daughter's, it is very difficult to say which disease is going on in family. But my advice is there is definitely strong family history and you should go for gebetical analysis.
Take also opinion of endocrinologist and oncologist regarding this. You will definitely get your answer.
2.There are some familial syndromes which can cause pheochromocytoma and Renal cell tumour.
I will give examexample of one -
Von hipple XXXXXXX syndrome (VHL)
But we cannot discuss much online.
At least I can guide you as an MD that you should go for further analysis at least for your children and grand children.
I hope I have given you satisfactory answer, if you feel the same Kindly rate the answer.
Thank you.
Have a nice day.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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