CASE 3: Effects of Catecholamines Objectives General After the discussion, the medical students shall be able to understand the

physiologic basis in diagnosin pheochromocytoma and discuss the hormones involved in the disease process Specific To be able to discuss pheochromocytoma To be able to explain the symptoms of pheochromocytoma Be able to discuss the hormones involve in pheochromocytoma

Clinical Manifestations Diagnosis Pheochromocytoma QUESTIONS: 1. What is the relationship between the adrenal medulla to the autonomic nervous system? The adrenal medulla is part of the adrenal gland. It is located at the center of the gland surrounded by the cortex. The adrenal medulla consists of irregularly shaped cells grouped around blood vessels. These cells are intimately connected with the sympathetic division of the ANS. The adrenal medulla is composed mainly of hormone producing chromaffin cells and release Ach. Once stimulated, the chro,affin cells will secrete catecholamines. 2. What hormones are secreted by a pheochromocytoma? Epinephrine and norepinephrine in large quantities severe menopausal symptoms heart raced and pounded; she had a throbbing headache and visual disturbances hot but her hands and feet were cold; and she was nauseated, sometimes the point of vomiting blood pressure was severely elevated at 200/110, and her heart rate was increased at 110 beats/min result of the 24-hour urinary VMA test were positive a 3cm mass on her right adrenal gland

3. Why does elevated urinary level of VMA ( a metabolite of epinephrine and norepinephrine) suggest the presence of a pheochromocytoma? Why is it necessary to do a 24-hour measurement of VMA, rather than a spot-urine test? VMA which is a metabolite of epinephrine and norepinephrine is secreted in the urine. With the presence of pheochromocytoma which produces large amounts of epinephrine and norepinephrine, execretion of VMA through urine is elevated. Normally, cateholamines and its metabolites are present in the body in small, fluctuating quantities that only increase during and shortly after bouts of stress. Because of this, a 24-hr urine sample is preferred than a spot urine sample. Pheochromocytoma secretes the hormone irregularly and the spot urine sample may not be accurate. 4. In view of the pathophysiology of pheochromocytoma, explain Mrs. River's symptoms, specifically, her increased heart rate, pounding heart, cold hands and feet, visual disturbances, and nausea and vomiting. What receptors are involved in each of these symptoms? a. Increase heart rate B1 receptor b. Cold hands and feet B2 receptor c. Visual disturbances contraction B1receptor _ dilation B2 receptor d. Nausea and vomiting Alpha 1, Alpha 2 , B1 and B2 receptors