What Is the Most Common Symptom of Pheochromocytoma?

Pheochromocytomas are rarely cancerous so for the most part, life expectancy is normal once a tumor is removed.

A pheochromocytoma is a rare, usually benign, tumor that can cause life-threatening high blood pressure (hypertension). The tumors produce too much catecholamine hormone [such as norepinephrine (noradrenaline), epinephrine (adrenaline), and dopamine] which can cause episodes of high blood pressure. In about 10% of cases, pheochromocytomas are malignant (cancerous) but they can be cured if they are surgically removed. 

Pheochromocytoma spells typically include four main symptoms:

• Headaches 
• Heart palpitations 
• Excessive sweating
• Severe high blood pressure (hypertension) 

These spells follow a pattern:

• Frequency of spells varies from several times daily to once a month
• The duration of spells varies from seconds to hours 
• Over time, spells usually occur more often and increase in severity as the tumor grows 

Other symptoms that may occur during a pheochromocytoma spell include:

• Tremor 
• Nausea 
• Weakness 
• Anxiety/panic attacks
• Stomach pain 
• Side pain 
• Constipation 
• Dizziness on standing caused by low blood pressure 
• Retinal damage due to high blood pressure
• Weight loss 
• Paleness (pallor)
• Fever 
• Tremor 
• Neurofibromas 
• Fast, irregular heartbeats 
• Excess fluid in the lungs (pulmonary edema)
• Heart muscle damage (cardiomyopathy)
• Disruption in movement of the bowel (ileus)
• Café au lait spots 

About one-third of cases of pheochromocytoma are caused by an inherited genetic mutation. The other two-thirds of cases do not have a known cause (idiopathic).

Pheochromocytoma spells may be caused by certain triggers, such as:

• Stress
• Physical activity
• Certain medications such as beta-blockers or anesthetics 
• Surgery
• Childbirth
• Massage
• Pressure on the tumor
• Foods that contain large amounts of the amino acid tyramine, such as chocolate, cheese, and red wine

Tests used to diagnose pheochromocytoma include:

• Plasma metanephrine testing 
• 24-hour urine collection for catecholamines and metanephrines
• Imaging studies
  • Abdominal CT scans 
  • Magnetic resonance imaging (MRI)
  • Scintigraphy
  • PET scans
• Other studies to rule out other conditions that have similar symptoms: 
  • Blood tests
    • Parathyroid hormone level 
    • Calcium level 
  • Screening for mutations in the ret proto-oncogene  
  • Genetic testing 
  • Consultation with an ophthalmologist to rule out retinal angiomas 

The preferred treatment for pheochromocytoma is surgical removal of the tumor, which usually cures the condition. 

Pre-operatively, patients may need to take medications to reduce blood pressure to prepare for surgery, such as: 

• Alpha-blockers 
• Beta-blockers
• Calcium channel blockers
• Angiotensin receptor blockers (ARBs)

Patients may also be advised to consume a high salt diet prior to surgery. 

Pheochromocytomas are usually not malignant (cancerous), but if they are, they may be treated with:

• Radiation
• Chemotherapy
• Antineoplastic medications

Complications of pheochromocytomas include:

• High blood pressure (hypertension) - most common complication 
• Irregular heartbeats 
• Inflammation of the heart muscle (myocarditis)
• Heart attack
• Enlarged heart that is unable to pump blood efficiently (dilated cardiomyopathy)
• Fluid in the lungs (pulmonary edema)
• Hypertensive encephalopathy
  • Altered mental status
  • Focal neurologic signs and symptoms
  • Seizures
  • Stroke 
  • Bleeding in the brain (intracerebral hemorrhage)
• Kidney failure
• Nerve damage in the eyes

Pheochromocytomas are rarely cancerous so for the most part, life expectancy is normal once a tumor is removed.
If pheochromocytoma is not diagnosed and treated promptly and the tumor is cancerous, the survival rate is diminished.