Dr-Shere

23/09/2025

18/09/2025

Shout out to my newest followers! Excited to have you onboard! Aiza Aiza, Asad Jani, Sarwan Kumar Menghwar, Amjad Khan

16/09/2025

Cellulitis Vs DVT ✅

14/09/2025

Important nail changes ✅

12/09/2025

❇️ Pheochromocytoma Points to Remember:
→ Tumor of chromaffin cells (neuroendocrine cells) of the adrenal medulla
→ Secretes catecholamines (mostly norepinephrine, sometimes epinephrine, rarely dopamine)

▶️ Pheochromocytoma Rule of 10s
→ 10% bilateral
→ 10% extra-adrenal (paragangliomas)
→ 10% malignant
→ 10% pediatric
→ 10% familial (but actually up to 40% are hereditary)

✔️ Associated Syndromes (Autosomal Dominant)
→ MEN 2A & 2B
→ Von Hippel-Lindau (VHL)
→ Neurofibromatosis type 1 (NF1)

✔️ Clinical Presentation
🛑 Classic triad
→ Episodic headache
→ Sweating (diaphoresis)
→ Palpitations/tachycardia

🩺 Other signs
→ Hypertension (sustained or paroxysmal)
→ Anxiety, tremors, weight loss
→ Orthostatic hypotension (due to volume depletion)
→ Hyperglycemia (catecholamines inhibit insulin)

✔️ Diagnosis

Initial test (high-yield):
→ Plasma free metanephrines or 24-hr urinary catecholamines/metanephrines

Confirmatory test:
→ Clonidine suppression test (in special cases)

Imaging:
→ CT/MRI of abdomen (for adrenal mass)
→ MIBG scan if extra-adrenal or metastatic

✔️ Treatment

Preoperative medical management:
→ α-blocker first: Phenoxybenzamine (non-selective, irreversible)
→ Then β-blocker: Propranolol or atenolol (to control tachycardia)
❗ Never give β-blocker first → unopposed α-vasoconstriction → hypertensive crisis

Definitive:
→ Surgical resection

✔️ Complications
→ Hypertensive crisis
→ Arrhythmias
→ Cardiomyopathy (catecholamine-induced)

06/08/2025

Aoa
One of our colleague Dr Ayesha Sohail TMO medicine Saidu group of teaching hospital swat is diagnosed with highly aggressive invasive grade 3 breast carcinoma,
To start the treatment we need funding,
Doctors decided to start with chemotherapy plus immunotherapy (pambraluzumab) which cost 5lac per dose), followed by mastectomy and then again chemotherapy+ immunotherapy+ radiotherapy
Before that it is mandatory to do BRACA1 and 2 mutations which will cost 2.5lacs
PET scan for about 1.5 Lacs
Chemotherapy per dose 15 to 20k
And she will need about 12 sessions of chemotherapy, 17 doses of immunotherapy.

Her treatment will require for more than one cror rupees
We need to raise funding for her treatment. It is requested to please contribute as much as you can. This will help us in her treatment.

Her easypaisa account:
03098757426 title:Ayesha sohail

Her jazcash account:
03098757426 title:Aisha sohail

Her bank account:Bank Name: HBL
Account Title: AYESHA SOHAIL
Account Number: 58477000015955
IBAN: PK63HABB0058477000015955
Branch: Saidu Sharif Swat

Thank you very much.