A woman with vomiting and hyperamylasaemia

Phaeochromocytoma can present in a variety of ways, including abdominal pain and vomiting. It can cause paroxysmal peaks of catecholamine secretion, producing episodic symptoms such as headache, palpitations or sweating. Our patient presented with vomiting alone, and the raised amylase led to the in...

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Bibliographic Details
Published in:The Lancet (British edition) 2002-01, Vol.359 (9300), p.42-42
Main Authors: Ma, R CW, Chan, WB, Chow, CC, Cockram, CS
Format: Article
Language:English
Subjects:
Abdomen
Adrenal Gland Neoplasms - complications
Adrenal Gland Neoplasms - diagnosis
Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
Amylases - blood
Biological and medical sciences
Case reports
Case studies
Endocrinopathies
Female
Humans
Hypertension
Medical diagnosis
Medical disorders
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pain
Pheochromocytoma - complications
Pheochromocytoma - diagnosis
Urine
Vomiting
Vomiting - etiology
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Summary:Phaeochromocytoma can present in a variety of ways, including abdominal pain and vomiting. It can cause paroxysmal peaks of catecholamine secretion, producing episodic symptoms such as headache, palpitations or sweating. Our patient presented with vomiting alone, and the raised amylase led to the initial suspicion of acute pancreatitis, even though she had no abdominal pain. However, the subsequent development of uncontrolled hypertension and the discovery of an adrenal mass suggested phaeochromocytoma. There are a few reports of phaeochromocytoma presenting with an acute abdomen and hyperamylasaemia.1-4 Such patients may be initially normotensive but subsequently develop labile blood pressure. Emergency surgery may result in death or life-threatening hypotension. It is important to recognise rare presentations of phaeochromocytoma, to avoid inappropriate surgery or inadequate preoperative preparation. The main sources of amylase are the salivary glands and pancreas, but certain tumours, particularly myeloma and bronchial cell cancer, are also associated with hyperamylasaemia.5 Hyperamylasaemia associated with phaeochromocytoma is due to an increase in the salivary isoenzyme, probably caused by ischaemic injury to amylase-containing tissue, or tumour production.2,3 In patients presenting with vomiting or acute abdomen with hyperamylasaemia, the finding of labile blood pressure should suggest the possibility of phaeochromocytoma.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(02)07278-1