Question

A 35-year-old male, married with 3 children, has experienced headaches and palpitations of increasing frequency and severity over the past six months. He has also had periods of intense anxiety and panic attacks. His wife has noted that his face is often pale and that he sweats more, although he feels chilled. Recently, he fainted upon standing up quickly. Examination of the patient revealed a pulse rate of 112 with a BP of 160/92.

What endocrine pathology would cause all of these symptoms and why does this pathology produce this number of diverse responses?
What is causing the headaches and palpitations of the heart?
Why is the patient sweating, even though he is chilled?

Answer 1

Based on the above symptoms patient is suffering with "PHENOCHROMOCYTOMA" Endocrine pathology that cause all these symptoms by the action of adrenal medulla:Hormones that was released from the adrenal medulla are

• Adrenaline(epinephrine)
• Noradrenaline(norepinephrine).
• 80% catecholamines are released from epinephrine.Hormones are secreted and stored in the adrenal medulla for stimuli.

Synthesis of Catecholamine:

• Tyrosine ia aminoacid that helps nerve cell to communicate and regulate mood.
• Tyrosine was hydrolyzed by the enzyme tyrosine hydroxylase which produce dihydroxyphenylalanine that converted into dopamine by catalyzing with L-aromatic amino acid decarboxylase.
• Dopamine is converted into norepinephrine by phenylethanolamine N-methyltransferase finally product epinephrine was synthesized.

Mechanism of action of catecholamines:

Receptors that are mediated are adrenergic receptors that is alpha and beta receptors. Peripheral effects such as heart rate,blood pressure,blood glucose level dependent upon the ratio type of receptors in the target tissues.

Receptor	Alpha	Beta
Norepinephrine	+++++	++
Epinephrine	++++	++++

Causing headache and palpitation of the heart:

Effect of epinephrine :

• Epinephrine secreted in the adrenal medulla.Epinephrine that was released into the blood stream which increase in heart rate and cause headache.
• Norepinephrine will constrict blood vessel leading to increased peripheral resistance that increased arterial pressure.
• Metabolism is by glycogenolysis in the liver and in skeletal muscle results in the mobilization of fatty acids that increased metabolic rate can lead to hyperglycemia that will increase oxygen consumption.

Sweating is one of symptom for the pheochromocytoma that is due to central activation of heat loss result in the passage of plasma catecholamines across the blood brain barrier that combined with the thermogenesis and cutaneous vasoconstriction.