Endocrine diseases seem to always affect the heart in some ways. Thyroid diseases certainly cause abnormal heart functions and diabetes causes atherosclerosis. The other day, I joked with a cardiologist that they should "steal one more disease from endocrinologists." This disease is pheochromocytoma.
The heart of a pheo patient is bombarded with catecholamines. Although most patients with pheo do not have obvious heart symptoms except for palpitation, ECG reveals subtle abnormalities in about half of the patients with pheo. In patients with large pheos, all kinds of severe heart problems can show up. I have seen myocardial infarction, congestive heart failure, and life-threatening arrhythmia in patients with pheo.
As patients with heart problems usually go to see cardiologists, and because pheo is so rare and not on the radar screen of cardiologists in the initial work-ups, delay in diagnosis is rather common. I am not here to say that all patients with common heart diseases should test for pheo. That would be impractical and common things are common. But if a relatively young patient without clear risk factors develops heart disease, pheo should be considered.
Surprisingly, little is known on why catecholamines cause heart damage. Another disease called Takotsubo cardiomyopathy has a lot in common with pheo. Takotsubo cardiomyopathy is a heart muscle diseases in patients with sudden and severe emotional or physical stress. If any colleagues have insights in heart diseases in pheo, please comment here.
The morals are: 1) if you have pheo but don't have heart symptoms, you should at least do an ECG to make sure you don't have a significant heart problem; 2) if you have heart problems and nobody knows why, consider pheo, at least as a long shot.
Dr. Pheo
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I am waiting with great anticipation your views on 24h urinalysis and scans. ie: how three 24x urine tests in a row show way above normal count and a month later the 24x is within accepted paramaters. A CT Scan has questionable masses (one in abdomen region aand another one in chest) both on the opposite side. Then the following CE Scan (two month later) does not interpret the the same results.
ReplyDeleteThanks,
Peep
In my case it was an inquisitive cardiologist who diagnosed my pheo. This was while the endo who had treated my diabetes for 4 years said no, it can't be a pheo. Thank goodness for inquiring minds.
ReplyDeleteAlso, regarding your April 2 post, you can set Blogger up to email you whenever someone writes a comment, even if it's on an older post. That's what I do with my Blogger blog.
ReplyDeleteDear Andrea,
ReplyDeleteThank you for your suggestion. It actually works well for me.
An inquisitive doctor is a good doctor, whichever specialty she/he may have. The most important trait of a good doctor is the ability to find that something is unusual or not right then follow that through.
Dr. Pheo
Dear Peep,
ReplyDeleteYour experience is actually not uncommon these days. I don't know if the urine test was catecholamines, metanephrines, or VMA. I guess it was metanephrines which in my experience tend to be most variable. There can be 2 explanations of variabilities. 1) Pheo can be episodic; 2) measurement errors (clerical, drug interference, and machine problems). I like to order plasma metanephrines and send them to Mayo Clinic Lab. They have not given me severely variable results yet. If you do want to find out what's going on with your urine test, I will send the urine metanephrines to another lab, not the one that gave the dramatic different results on the same patients. If there are no errors involved, it is not very likely you have pheo.
About episodic secretion by pheo. This is only my personal experience and perhaps biasded opinion: I don't buy that very well. It is certainly true that metanephrines are much higher during a spell, but I have yet to see a patient with a sizable pheo who genuinely has normal metanephrines when not having a spell.
About pheo imaging. Please see my new post which I promised a few weeks ago.
Dr. Pheo
Hi , I have mastastic pheo , just letting you know that all pheos may be different in what they express, my tumors excrete dopamine and that's it.
ReplyDeleteWhich creates a whole different set of problems.
Islandbound
Thank you for pointing that out. Dopamine-secreting only pheos are very rare. It is actually controversial whether the dopamine causes clear symptoms. Most of this kind of pheos are first found because the tumor compress surrounding organs rather than cardiovascular symptoms. How was yours diagnosed? I'd also like to know what kind of different set of problems your pheo causes.
ReplyDeleteDr. Pheo
Dr Pheo, my 80 year-old mother who had her pheo removed successfully a couple of months ago had an echocardiagram today and was told her heart is twice the normal size (she will see the cardiologist in 2 weeks time). Is this likely to be the effect of living with a pheo? (the surgeon estimated it had been growing for 10 years; final size, over 5 cm).
ReplyDeleteThanks!
It is possible but not certain. The larger the tumor and the higher the marker levels, the more evident is the heart injury. The heart damage caused by pheo is usually reversible after pheo resection, usually returning to normal in a few months.
ReplyDeleteIn an 80-year-old, coronary artery disease is the most common cause of heart disease.
Dr. Pheo