Endocrine Abstracts (2012) 29 P119

Neither classical symptoms of phaeochromocytoma nor elevated urinary catecholamines are always seen in patients with histologically verified phaeochromocytoma

S. Lumley, R. Reddy, N. Karavitaki & J. H Wass

University of Oxford, Oxford, UK.

Background: The symptom triad of ’headaches, palpitations and sweating’ along with elevated urinary catecholamine levels are commonly used to diagnose phaeochromocytoma. We wanted to assess how often patients with histologically verified phaeochromocytoma did not have this triad or had normal urinary catecholamine excretion on one occasion or more.

Methods: Retrospective analysis of clinical presentation and urinary catecholamine levels in 75 patients with phaeochromocytoma in Oxford.

Results: Clinical features: Palpitations were the most commonly reported symptom (67%), followed by sweating (66%), hypertension (65%) and headache (63%). 12% did not have any of the classic triad of headache/palpitations/sweating, 8% did not have the classical triad or hypertension. Of these 8% (six patients), five patients were completely asymptomatic and one presented with isolated abdominal pain.

Urinary catecholamines: Pre-operative biochemical urine analysis was available for 51 patients; 44 had all three of normetadrenaline, metadrenaline and 3-methoxytyramine measured.

90% (4/44) had normal urinary catecholamine excretion on one occasion or more. Of these 4 patients, 1 (2% of the cohort) had multiple normal readings (on 6/7 measurements), 1 patient did not have levels repeated. The remaining 91% had at least one elevated urinary catecholamine on every measurement.

71% had one or more occasions where one of the catecholamines was normal, 3-methoxytyramine was most likely to be normal at some point during investigation (59%).

Conclusions: The triad of headaches, palpitation and sweating misses 12% of cases. The inclusion of hypertension to form a tetrad reduces this to 8%.

Normal urinary catecholamines on one occasion are not sufficient to exclude a phaeochromocytoma. If there is a strong clinical suspicion they should be repeated, only 2% had multiple normal readings.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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