Does your blood pressure rise inexplicably without warning? Is your cocktail of medications unable to control your blood pressure level? Are you frustrated that despite a conscious effort to avoid risk factors, you continue to be an uncontrolled hypertensive? Are you fearful that the next blood pressure rise will lead to more serious consequences? Do you have a familial history of unexplained hypertension?
At a forum held recently, Dr. Leilani Mercado-Asis, head of the University of Santo Tomas Hospital Section of Endocrinology and Metabolism, explained that one cause of extreme high blood pressure is the growth of tumors in the adrenal glands. Called pheochromocytoma, it is admittedly a rare disease that can occur in children and young adults. However, with its effect of causing blood pressure to rise to a reading of up to 260/160 mm Hg, the condition can lead to a stroke, heart attack, or may even be fatal. In effect, one may not succumb to pheochromocytoma per se, but will succumb to its consequences.
The adrenals are endocrine glands located on top of the kidneys. Their function is to produce hormones that influence growth and development, help regulate kidney function, and determine an individual’s ability to deal with stress. The outer portion of the adrenal gland is called the cortex and is responsible for producing the hormones that affect blood pressure and blood sugar level, growth, and certain sexual characteristics. The inner part or medulla produces epinephrine (adrenaline) and norepinephrine, the hormones that are responsible for the “fight or flight” response. When a person is subjected to stress, his adrenals secrete hormones to enable him to deal with the changes in his environment.
To explain to lay people how the hormones from the adrenals work, the “adrenaline rush” is the familiar illustration: When a person is subjected to extreme stress (say, during a fire) the adrenals secrete hormones that boost his strength. This enables that person to single-handedly carry a heavy object (like a refrigerator) that he will be unable to lift under normal circumstances. A balance in the levels of hormones secreted by the adrenals is important. Needless to say, how well you live depends on adrenal gland function. A tumor can disrupt hormonal secretions and consequently increase blood pressure to extreme and possibly fatal levels.
What are the warning signs of pheochromocytoma? Headaches, sweating, pounding of the heart, chest pain, and anxiety are also indicators of high blood pressure. However, patients with no risk factors may additionally undergo blood and urine tests to determine if there are extra hormones in the body. The physician may also require CT or MRI scans of the adrenals. If a tumor is found, standard treatments include surgery, radiation therapy, and chemotherapy.
Dr. Asis is quick to clarify, “The tumor may not be cancerous.” She adds that some tumors are too small to be seen using the usual diagnostic tools. Thus, a comparison of hormone levels from the right and left adrenals is done, as this may indicate pheochromocytoma.
A research collaboration of the UST Hospital Section of Endocrinology and the US National Institutes of Health in Bethesda, Maryland is positive news for Filipino patients with pheochromocytoma. Apart from the involvement of Dr. Karel Pacak, who is an authority on the management of the disease, all Filipino patients who are diagnosed will be given an opportunity to undergo genetic testing at minimal cost. Moreover, their immediate family members can avail themselves of free screening for early diagnosis and treatment before complications can set in.
“This study will give an opportunity for our countrymen to be worked up for a very costly disease. This will enable us to formulate Asian data on the disorder and, with early diagnosis, it can be more effectively treated,” says Dr. Leilani Mercado-Asis. “Our groundbreaking partnership with NIH provides an opportunity to complement the world-class training that doctors undergo in our country.”
Patients who are interested in being screened for pheochromocytoma may get information from Dr. Jeremy Robles at mobile number 09173218880 or e-mail docjercebu@msn.com.