Adrenal Medulla

Adrenal medulla secretes the hormones epinephrine and nor-epinephrine. They are our flight or fight hormone. Remember exam days, we used to get so tensed! That is because excess Adrenaline. The most common problem of this part of the adrenal gland is the tumor called phaeochromocytoma, which secretes excess of these hormones.

The common features of this are high blood pressure that is difficult to control, episodic headache, sweating, flushing, faster heart beats and difficulty in breathing. If left untreated such patients suffer from heart failure, pulmonary edema or encephalopathy i.e. damage to brain.

Sometimes a crisis situation takes in these patients leading to very high blood pressures requiring admission to the hospital. These can be life-threatening conditions. Straining, exercise, surgery, pressure on the tummy, anesthesia, taking beta-blocker group of drugs only for blood pressure and certain other drugs, precipitate these.

The confirmation is done by testing a 24-hour urine sample for VMA, metanephrines and free catecholamines. Certain precautions are required before this test is performed.

How the Test is performed:

  • A 24-hour urine sample is needed. On waking up urinate in the morning and do not collect it. Your time starts now.
  • Collect all subsequent urine (in the special container) throughout the day and night
  • Keep it in a cool place during the collection period.
  • Next day at the same time urinate into the container. This completes your collection.
  • Cap the container& return it as instructed.

Following are to be avoided during the collection for three days prior to the test.

Foods: Coffee, bananas, chocolate, citrus fruits, and vanilla.

Drugs: Levodopa, lithium, aminophylline, clonidine, erythromycin, methyldopa, quinidine, tetracyclines, nitroglycerin, imipramine, phenothiazines, salicylates, metoclopramide, domperidone, hydralazine, decongestants.

After confirming the disease, next step is to do certain tests to localize the tumor and to know how far it has spread in the body. These include MRI scan, 123I- MIBG scan or venous sampling if the first two fail to demonstrate anything.

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Treatment is the surgical removal of the tumor. But before the surgery is performed the blood pressure has to be controlled initially with a drug called phenoxybenzamine with addition of propranalol 48-72 hrs later. To assess the cure 24 hour urine is tested for free catecholamines after 2 weeks. If the tumor is cancerous then long term drugs as mentioned above are needed to control the BP. High dose 123I- MIBG, chemotherapy are required for those tumors which have spread in the body.