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.
King
Kathryn S
KS
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.
Darmani
Nissar A
NA
Hughes
Marybeth S
MS
Adams
Karen T
KT
Pacak
Karel
K
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