ADRENALIN PRODUCING TUMOR (PHEOCHROMOCYTOMA) CONTAINING 2300 MG. OF ADRENALIN

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Abstract
Pheochromocytoma, the "physiologically malignant" and histologically benign adrenal medullary tumor, produces a clinical picture almost identical with that produced by large doses of epinephrine. The case report and confirmatory tests used to substantiate the diagnosis have given the authors an opportunity to study the effects of otherwise prohibitive amts. of epinephrine in the blood. The patient presented the classical picture of the disease and reacted in an expected manner to a number of confirmatory clinical tests. Viz.[long dash]production of attacks by (1) psychic stimulus, (2) injn. of extremely small amts. of histamine acid phosphate .025 mg., (3) cold pressor test, and (4) massage over adrenal tumor. The syndrome associated with pheochromocytoma is characterized mainly by acute unpredictable attacks lasting from a few secs. to several hrs. In a typical attack, there is sudden cardiac palpitation with either an increase or decrease in pulse rate (depending on the reflex mediated via the carotid sinus pressor mechanism) and a very marked rise in blood pressure. (Blood pressures above 320 mm. Hg systolic were recorded in this patient.) The patient notices a feeling of fullness in the throat and choking, and perhaps fullness, pressure, pain or burning beneath the sternum and in the epigastrium. There are often noted tingling and blanching of the extremities and the tip of the nose; pallor is followed by flushing. The patient characteristically feels nervous or anxious, tremulous and weak and has a headache, vertigo, blurred vision, mydriasis and perhaps tinnitus and air hunger. Polyuria is common and gastrointestinal symptoms such as sialorrhea, nausea, vomiting, colic and diarrhea are not infrequent. Epiphora is often noted. Other objective findings are angiospasm in the ocular fundi, glycosuria, albuminuria, hypermetabolism, and hyperglycemia. Unusual susceptibility to surgical shock and pulmonary edema is also characteristic. Adrenalin content of the tumor was detd. by biologic assay with decerebrated and pithed dogs and by colorimetric comparison of the extract of the gland with standard adrenalin solns. Total amt. calculated was 2,349 mgs.