Neurological manifestations of phaeochromocytomas and secretory paragangliomas: a reappraisal
- 1Department of Neurology, Auckland Hospital, Auckland, New Zealand
- 2Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand
- Correspondence to Dr Neil E Anderson, Department of Neurology, Auckland City Hospital, Private Bag 92024, Auckland 1, New Zealand;
- Received 3 May 2012
- Revised 23 October 2012
- Accepted 2 November 2012
- Published Online First 1 December 2012
Objective To determine the frequency and range of neurological manifestations of phaeochromocytomas and secretory paragangliomas.
Methods A retrospective review of case notes of patients admitted to Auckland Hospital from 1985 to 2011 with a discharge diagnosis of phaeochromocytoma or secretory paraganglioma.
Results Ninety-three patients were admitted with a phaeochromocytoma or secretory paraganglioma. Sixty-eight patients (73%) had neurological symptoms, but only 15 patients (16%) received a neurological consultation. Neurological manifestations occurred in three main clinical contexts. First, paroxysmal symptoms occurred in 66 of 93 patients (71%). Neurological symptoms were common features of these attacks and included headache (47 patients), anxiety (24 patients), tremulousness (15 patients) and dizziness (12 patients). The headaches typically had an explosive onset. Delay in diagnosis was common. Second, 28 patients (30%) had an acute crisis, which was associated with neurological symptoms in 11 (39%) of the episodes: headache (10 patients); seizures (five patients); strokes (three patients); delirium (three patients) and subarachnoid haemorrhage (one patient). Third, five of six patients with a head and neck secretory paraganglioma had neurological symptoms related to infiltration of the middle ear or compression of cranial nerves. Reversible cerebral vasoconstriction syndrome (RCVS) was documented in three patients.
Conclusions Neurological manifestations of phaeochromocytomas and secretory paragangliomas were common, and these tumours can present with various neurological manifestations. The paroxysmal symptoms can be incorrectly attributed to other headache syndromes, panic attacks or cerebral vasculitis. RCVS may play a role in the pathogenesis of the neurological symptoms associated with acute crises and paroxysmal attacks.