Pheochromocytoma (adrenaline-producing adrenal tumor)
Signs and Symptoms
Patients with pheochromocytomaPheochromocytoma - a disease where too much adrenaline is being made by an adrenal tumor present in one of 4 ways: classic symptoms (40%), in "pheo crisis" (10%), as an incidental finding (40%), or during screening for genetic or familial disease (10%).
Hypertension (i.e. high blood pressure) is the most common symptom of pheochromocytoma. The high blood pressure can either be continuous (i.e. most of the time) or episodic (i.e. happens every once in awhile). Although most patients will have high blood pressure, about 5 to 15% of patients present with normal blood pressure. In addition, the classic 3 signs and symptoms or "triad" of pheochromocytoma are headaches, palpitations (i.e. rapid heart rate), and sweating. Difficulty breathing, weakness, and panic attack-type symptoms can also occur in this classic presentation. Only about 40% of patients have this classic triad of symptoms. It is important to remember that high blood pressure is very common in general and does not necessarily mean that someone has a pheochromocytoma, even if the patient has headaches, palpitations, and sweating. Other less common signs and symptoms include: pale skin (pallor), low blood pressure, blurred vision, weight loss, increased thirst and urination, constipation, abdominal pain, elevated blood sugar and white blood cell counts, psychiatric disturbances, heart muscle dysfunction (cardiomyopathy), and an elevated red blood cell count. When these symptoms occur during a procedure (e.g., anesthesia, colonoscopy, angiography) and following ingestion of certain food ingredients or drugs (e.g., phenylephrine, monoamine oxidase [MAO] inhibitors, tyramine), a prompt evaluation for pheochromocytoma should be performed.
Approximately 10% of patients present in "pheo crisis" which is a life-threatening release of adrenalineAdrenaline - the hormone that helps control the "fight or flight" response and puts the body on "high alert" (also known as epinephrine) that can lead to stroke, heart attack, organ failure, coma, and even death.
Approximately 40% of patients will be found to have a pheochromocytoma incidentally (i.e. during an imaging test being done for another reason). (See Adrenal Incidentaloma) Occasionally, pheochromocytomas may only be found at autopsy (i.e. the examination after someone has passed away).
Screening for genetic or familial disease
Up to 10% of patients will be found to have a pheochromocytoma during genetic screening after another family member has been diagnosed with pheochromocytoma or one of the associated inherited diseases. (See Pheochromocytoma → What is the chance that this is genetic?)