Subjective
Date of visit
Reason for visit (initial presentation, follow-up)
History of present illness:
Symptoms suggestive of catecholamine excess (episodes or constant):
Paroxysmal episodes (sudden and severe):
Headaches (sudden, severe, throbbing)
Sweating (profuse)
Palpitations (rapid heart rate)
Pallor (pale skin)
Tremor (shaking)
Anxiety or shortness of breath
Constant symptoms:
Hypertension (may be difficult to control with medications)
Headache
Weight loss (unintentional)
Family history (presence of pheochromocytoma or paraganglioma in relatives)
Past medical history (relevant conditions, previous surgeries)
Medications (current medications)
Allergies
Objective
Vital signs (blood pressure – note for paroxysmal episodes if present)
Physical exam:
General (signs of anxiety or hyperadrenergic state)
Cardiovascular examination (looking for signs of heart failure or rhythm abnormalities)
Fundoscopic exam (eye exam to check for retinal changes)
Assessment
Pheochromocytoma or paraganglioma (suspected based on clinical presentation)
Location (adrenal vs. extra-adrenal) – consider if specific symptoms point to a particular location
Malignancy (consider risk factors and family history)
Plan
Diagnostic testing:
Biochemical testing:
Urine and plasma metanephrines (sensitive tests for catecholamines)
Fractionated metanephrines (may differentiate pheochromocytoma from paraganglioma)
Plasma normetanephrine (alternative test)
Imaging studies:
CT scan or MRI scan (to localize the tumor)
MIBG scan (radioisotope imaging for specific tumor type)
Genetic testing (may be considered in some cases)
Management:
Preoperative management (essential for blood pressure control before surgery):
Alpha-blocker medications (first-line to control blood pressure and symptoms)
Beta-blocker medications (added cautiously after alpha-blockade)
Calcium channel blockers (may be used in some cases)
Surgical resection (minimally invasive laparoscopic approach preferred) – curative for benign tumors
Radionuclide therapy (metastatic or unresectable tumors)
Medications for long-term management (if not surgically cured)
Education
Explain the diagnosis, potential causes, and treatment options
Importance of medication adherence for blood pressure control
Discuss the potential for lifelong follow-up if not cured
Follow-up
Schedule for next appointment:
Monitor response to treatment (blood pressure control, symptom improvement)
Repeat testing to assess response (if appropriate)
Consider referral to an endocrine surgeon or specialist for further management
Note: This template is a guide and may need to be modified based on the individual patient’s presentation, severity of symptoms, and test results.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pheochromocytoma and paraganglioma.