Exercise-induced nausea and vomiting: another sign and symptom of pheochromocytoma and paraganglioma.
A cohort of nine patients, mostly young adults, presented with a new sign/symptom of pheochromocytoma/paraganglioma: exercise-induced nausea and vomiting. The aims of this article are to introduce this sign/symptom and offer a possible hypothesis for the observation. Following a 2000 report from a paraganglioma patient experiencing exercise-induced nausea and vomiting, we began asking patients about instances of nausea and vomiting with exercise. A total of nine patients, 4.4% of our pheochromocytoma/paraganglioma population, presented with reports of exercise-induced nausea and vomiting, initially with moderate-to-intense levels of exercise, at the first presentation of their disease. All of these patients reported a cessation of exercise-induced nausea and vomiting following the removal of their primary tumor. Two patients with metastatic disease to the lungs reported a recurrence of exercise-induced nausea and vomiting. The majority of patients studied were young adults with mean onset age of 19.4 years (range of 9-51 years) and the mean age of diagnosis being 24.1 years (range of 11-53 years). Exercise-induced nausea and vomiting should be considered a sign/symptom of pheochromocytoma/paraganglioma and should be addressed in the clinical evaluation of these patients, especially in young adults. Whether exercise-induced elevated catecholamine levels could account for the induced nausea and vomiting via activation of adrenergic receptors in the area postrema remains to be established.
Section on Medical Neuroendocrinology, Reproductive and Adult Endocrinology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development NICHD, National Institutes of Health NIH, Building 10, CRC, 1-East, Room 1-3140, 10 Center Drive, MSC-1109, Bethesda, MD 20892-1109, USA.
Kathryn S
KS
King
Nissar A
NA
Darmani
Marybeth S
MS
Hughes
Karen T
KT
Adams
Karel
K
Pacak
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D002648:Child; D004298:Dopamine / Q000097:blood; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008676:Metanephrine / Q000097:blood; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D009638:Norepinephrine / Q000097:blood; D010235:Paraganglioma / Q000175:diagnosis* / Q000556:secondary; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000556:secondary; D014839:Vomiting / Q000209:etiology*; D055815:Young Adult
D008676:Metanephrine; D004298:Dopamine; D009638:Norepinephrine