ADMIN - BHARATH RAJ KIDAMBI
MBBS - SSR MEDICAL COLLEGE MAURITIUS
MD - INTERNAL MEDICINE - MADRAS MEDICAL COLLEGE
DM - CARDIOLOGY - AIIMS NEW DELHI

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Sunday, February 20, 2011

Pheochromocytoma - The controversial question solved

Hello dear friends,
Dr. Gowthami had asked a very nice question, which really seemed pretty easy at first but took a lot of research to find out the right answer.
The question is what appeared in AIIMS paper, november 2001.


Q)Pheochromocytoma predominantly secretes.

A)epinephrine
B)nor-epinephrine
C)dopamine
d)DOPA

The answer given in Amith Tripati book for medicine PGMEE is wrong! the answer is given as epinephrine, which i have tried to get references, but could not get any.
The AIIMS book by Amith Ashish gives the right answer nor-epinephrine.

From what i could get from Williams endocrinology, Journal of endocrinology and Harrison the answer is nor-epinephrine.
Harrison say`s :- "In Pheochromocytoma,nor-epinephrine is more than normal adrenal production"
which is the reason why people manipulate this statement and understand it the way they want! Harrison does not say anything about epinephrine production.
From other books,
Normally adrenal medulla secretes epinephrine-85% as it has a methyl transferase enzyme. In phaechromocytoma, this enzyme is missing and it produces nor-epinephrine predominantly. Extra adrenal tumors produce nor-epinephrine exclusively!
Epinephrine producing tumors exclusively are rare about 15%, and only dopamine producing tumors are very very rare.
Below i provide a link which can give some support to my answer. You can refer any standard textbook.


Pheochromocytoma: eMedicine Endocrinology

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