Pheochromocytoma

These are rare tumours

90% arise from the adrenal medulla while 10% from elsewhere in the sympathetic chain.

About 10% are malignant.

Pheochromocytoma secretes catecholamine and is responsible for <0.1% cases of hypertension.

Clinical features

Some patients present with signs and symptoms of excessive catecholamine secretion while some present with complications of hypertension such as stroke, myocardial infarction, left ventricular failure or hypertensive retinopathy.

Symptoms and Signs

• Anxiety or panic attacks

• Palpitations

• Hypertension -intermittent or constant

• Tremor

• Tachycardia

• Sweating

• Arrhythmias

• Headache

• Bradycardia

• Flushing

• Orthostatic

• Nausea/ vomiting

Pallor or flushing

• Weight Loss

• Glycosuria / Polyuria

Constipation or diarrhoea

• Fever

• Raynaud’s phenomenon

• Chest pain

(Signs of hypertensive damage)

Investigations

• 24-hour urinary (VMA) or metanephrine and normetanephrine is a useful screening test. (These are the
metabolites of adrenaline and noradrenaline).

• CT scan of abdomen for the localization of tumour.

• Scanning; useful for extra-adrenal tumours.

Surgical

The tumour should be removed