Endocrine Abstracts

Background and Objective: Pheochromocytomas are rare tumors, originating from chromaffin cells of the adrenal medulla. The typical presentations include the Menard triad (headache, palpitations, sweating) accompanied by sustained or paroxysmal hypertension. Some studies on animals support that high levels of catecholamines have been implicated in the development of the vomiting responses, by activating the alpha-adrenergic receptors in the area postrema, which triggers the emetic cascade. Nevertheless, literature data on human studies is sparse. The aim of our study was to document and investigate nausea and vomiting as relevant and key-symptoms in patients diagnosed with pheochromocytoma.

Methods: We performed a 23-year retrospective study on all pheochromocytoma cases registered at Târgu-Mureş Pathology Departments, Emergency and County Mureş Hospitals, respectively, between 2000 and 2022. Demographic and pathological data were retrieved from institutional database registries and original pathological reports. All patients were subject to a phone questionnaire which provided data related to symptoms and body weight changes (before and after surgery for pheochromocytoma).

Results: Thirty-four patients (n=34) with pheochromocytoma were registered in our departments over the study period (women/men ratio:1.26, mean age: 51.66 years, mean tumor size: 67.83 mm). Subsequently, we were able to obtain clinical data for 25/34 of these patients. Approximatively half of them (n=13/25, 52%) complained of nausea and vomiting, symptoms that ceased following surgery for pheochromocytoma. The mean age of the symptomatic patients was 56.07 years, the majority were women (women/men ratio: 3.33) and the mean tumor size was 65.16 mm. When looking at the mean Body Mass Index for these patients we observed an increased postoperative value, from 27.34 kg/m² before to 28.84 kg/m² after surgery.

Conclusion: Although hypertension is the hallmark sign of pheochromocytoma, some patients complain of atypical symptoms, mimicking many other diseases. Our data revealed that nausea and vomiting could be considered as key-symptoms in the diagnosis of pheochromocytomas and should be documented in the history of these patients.

Ackowledgemets: This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureş Research Grant No. 164/10/10.01.2023.

Keywords: pheochromocytoma; nausea; vomiting; catecholamines