Non-functioning tumorsóthose that don't produce hormonesóare frequently discovered by CT or MRI. Patients may also have abdominal masses, often with pain, weight loss or evidence of metastasis .
The hormonally active tumors produce a variety of symptoms. Women may have signs of masculinization (virilization) such as excess body and facial hair, a decrease in menstrual periods or enlargement of the clitoris. Breasts can become enlarged in men. Puberty may come early to children. The signs of Cushing's syndrome include swelling of the face and back of the neck, along with bruising and purple lines over the abdomen. Hypertension and signs of diabetes may appear.
People with a pheochromocytoma typically have attacks of anxiety and marked or sustained high blood pressure. Hypertensive crises may occur during minor operations or after trauma or exercise. The blood pressure often falls when the person rises from a sitting position. Other symptoms include headaches, sweating, palpitations and a rapid heartbeat.
Pheochromocytomas can produce other hormones besides norepinephrine, including ACTH, epinephrine and dopamine, so that some patients may also have Cushing's syndrome. If these tumors occur in both adrenal glands, this may represent a component of multiple endocrine neoplasia (MEN II), which includes medullary carcinoma of the thyroid gland ( See "Thyroid" ) and multiple abnormal parathyroid glands.
