Hypertension: absence of the triad of headaches, palpitations and sweating attacks made phaeochromocytoma unlikely

Clinical bottom line (level 4)

  1. Less than 0.5% of patients with hypertension had a phaeochromocytoma.
  2. Patients with hypertension who have headaches, palpitations and sweating attacks were at increased risk of having a phaeochromocytoma.
  3. Patients without all three symptoms were very unlikely to have a phaeochromocytoma.
Plouin et al: La Nouvelle Presse Medicale 1981; 10 (11): 869-872
Expires October 2003

The study

Setting: 5 hypertension clinics, acute hospital, France

2585 patients (aged ~47, 56% male) with hypertension

Independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • surgery or follow-up
Diagnostic test: presence of all 3 of headaches, palpitation and sweating attacks

The evidence

pre-test probability of phaeochromocytoma: 0.43%, (95% CI: 0.17% to 0.68%)

diagnostic test phaeochromocytoma no phaeochromocytoma LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
all of headaches, palpitations and sweating attacks 10 160 15
(12 to 19) 		5.9% 0.10
(0.01 to 0.63) 		0.041%
total 11 2574

Comments

  1. Because this study did not undertake a systematic assessment of urine catecholamine or other investigative approaches used to identify pheochromocytoma its conclusions must be analysed with caution. It remains possible that in the 49% of matched patients without urine VMA testing, their could have been some false negatives.
  2. It is unclear if findings in this population of relatively young patients can be extrapolated to the majority of hypertensive patients that are seen by general practitioner.

Citation

  1. Plouin P-F, Degoulet P, Tugaye A, et al: Le depistage du pheochromocytome: chez quels hypertendus? Etude semiologique chez 2585 hypertendus dont 11 ayant un pheochromocytome. La Nouvelle Presse Medicale 1981; 10 (11): 869-872
Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer: Jean Legare

Clinical Question.
Patient hypertension
Intervention or Exposure symptoms of headache, sweating, palpitations
Outcome phaeochromocytoma