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Endocrine - Adrenal

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I don't know if you can help me but I've just been told I've got something called phaeochromocytoma. Basically I went to see my GP a few months ago because I'd been having lots of headaches, feeling very anxious and even getting hot flushes (I'm a 39 year old man and I thought only women going through the change got those!) My blood pressure was high so after lots of messing about with pills and various tests my GP sent me to see a specialist who diagnosed phaeo. I've been diving for years and it is a huge part of my life. I really don't want to stop, but the specialist thought it might be too risky to continue. What do you think?

A - I think your specialist might be right I’m afraid. Phaeochromocytomas (let’s call them phaeos otherwise this will be a very long answer) are rare tumours of stuff called chromaffin tissue. In humans this is mainly found in the adrenal glands, just above the kidneys. As you might expect, the adrenal gland secretes adrenaline (and a related compound called noradrenaline), and so a tumour of this sort leads to hugely excessive amounts of these hormones entering the blood. The symptoms that result are those of adrenaline overload: rapid heart rate, high blood pressure, palpitations, anxiety or panic attacks, sweating, headaches, pale skin and weight loss, to name a few. The old test for a phaeo was to see whether a gentle shove of the adrenal gland would trigger off a bout of symptoms – thankfully there are subtler diagnostic tools these days.

The main problem with diving with a phaeo is that the symptoms can come on suddenly in paroxysms or “episodes”, without warning. You can see the problem if this was to occur underwater. But all is not lost. Most phaeo’s are actually benign, ie. non-cancerous, and although technically challenging, surgical resection of phaeo’s is undertaken with good success rates these days. Sometimes the tumour itself can be removed, occasionally the whole adrenal gland has to be chopped out, but 95% of people are alive 5 years after surgery (this is a pretty good statistic). Once you’re rid of the pesky thing it should be possible to return to the wet stuff.

(other dive medical questions)


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