A pheochromocytoma is a rare tumor of the adrenal medulla that releases bursts of catecholamines such as epinephrine and norepinephrine. It causes high blood pressure and sudden spells, and up to a third of cases are inherited.
Key symptoms
- Pounding headache
- Heavy sweating
- Palpitations and a fast heartbeat
- Spells of anxiety, pallor and tremor
- Spells triggered by stress, exercise, surgery or some drugs
What you find on exam
- High blood pressure, constant or in spells
- Drop in blood pressure on standing
- Fast pulse and tremor
- Pale skin during an attack
- Signs of genetic syndromes: thyroid nodule, skin neurofibromas
Tests
- Plasma free metanephrines or 24-hour urine metanephrines
- CT or MRI of the adrenals after positive blood or urine tests
- ECG and echocardiogram for heart damage
- Genetic testing for every patient
Treatment basics
- Alpha blockade first with phenoxybenzamine or doxazosin for 1 to 2 weeks
- Beta blocker only after alpha blockade is in place
- Salt and fluids before surgery to restore volume
- Laparoscopic adrenalectomy
- Lifelong follow-up with metanephrines
Red flags
- Blood pressure over 180/120 with chest pain, headache or vision change
- Crisis after a beta blocker alone, steroids or contrast
- Arrhythmia or heart failure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AHA Scientific Statement, Measurement of Blood Pressure in Humans (Hypertension, 2019). Written by Making Synapses. Making Synapses is not affiliated with these organizations.