Symptoms of Pheochromocytoma

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Pheochromocytoma is a rare tumor that develops in the adrenal glands. This type of tumor produces excess amounts of fight-or-flight hormones called catecholamines. These hormones can trigger symptoms such as high blood pressure, sweating, anxiety, palpitations, and headaches.

Pheochromocytoma symptoms often occur dramatically in episodes (paroxysms) that can happen a few times a week, or only once every few months. In adults, the symptoms may be like having a panic attack (including a feeling of impending doom). Children experiencing symptoms may be be anxious, jittery, or hyperactive.

This article will review the common and rare symptoms associated with pheochromocytoma, as well as potential complications and when to see your healthcare provider.

Women having heat palpitations

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Frequent Symptoms

Pheochromocytoma symptoms are similar to many other conditions, but the combination of symptoms and the dramatic nature of how they occur can be a red flag and an indication of this condition.

The most common symptoms overall include:

  • High blood pressure (hypertension), which can be chronic (ongoing) and may occur in episodes
  • Sweating (often profuse, drenching)
  • Headache (often severe)
  • Palpitations or a sense of a heavily beating heart
  • A sense of impending doom
  • Tremulousness (trembling) pr tremors

In one study, almost 80% of people with pheochromcytoma had high blood pressure, and 53% had the classic triad of high blood pressure, sweating, and headaches.

When to Seek Emergency Medical Care

Blood pressure spikes related to a pheochromocytoma are often severe and alarming. It's important to note that severely elevated blood pressure can lead to immediate complications. And 1 in 14 people with a pheochromocytoma present or are first diagnosed when they have a heart attack.

In the past, the term "malignant hypertension" was used to describe this extreme elevation. It is now usually referred to as a hypertensive crisis. A hypertensive crisis is defined as:

  • A systolic blood pressure (top number) greater than 180 millimeters of mercury (mm Hg)
  • A diastolic blood pressure (bottom number) greater than 120 mm Hg
  • Evidence of end-organ damage, meaning that the high blood pressure is causing secondary problems, such as damage to the retina of the eye and more

Other common symptoms include:

  • Nausea, or vomiting
  • Unintentional weight loss, due to increased metabolism associated with chronic catecholamine release
  • Dizziness
  • Constipation (difficulty having a bowel movement)
  • Orthostatic hypotension (light-headedness, or fainting when getting up quickly from a lying down or seated position)
  • Fatigue
  • Paresthesia (tingling or numb sensations in the arms and legs)

Some Tumors Are Asymptomatic

Early on, a pheochromocytoma may have no symptoms. These tumors are usually discovered incidentally, that is, when an imaging test of the abdomen, such as a CT (computed tomography) or MRI (magnetic resonance imaging) scan, is done for an unrelated condition.

In one study, 61% of the tumors were detected "accidentally" on imaging studies, and another 4% were found when screening was done due to a genetic syndrome.

Recognizing a Paroxysm or Episodic Crisis

A unique feature of pheochromocytoma for around 60% of people is the occurrence of crises, or paroxysms. Between these episodes, people may have no symptoms or only high blood pressure.

During these paroxysms, the tumor secretes larger amounts of catecholamines, leading to fairly classic symptoms, including rapid heart rate, sweating, anxiety and a sense of impending doom—often similar to what you might experience if you are suddenly very frightened.

Episodes may occur frequently, or instead, may only be seen once every few months. When present, the paroxysms may last only a few minutes, or they can instead last for hours. Over time, both the frequency of episodes as well as their duration and severity tend to increase.

Paroxysms may be triggered or precipitated by anything that can cause a release of catecholamines from the tumor. These can include:

  • Changes in pressure, such as anything that displaces the organs in the abdomen
  • Eating foods high in tyramine, such as chocolate, red wine, cheese
  • Intense physical activity
  • Injury or illness
  • Glucagon (given intravenously)
  • Needle biopsy of a mass (removing tissue or fluid for examination in a lab)
  • Anesthesia (medication given during surgery)
  • Childbirth
  • Surgery, including cesarean sections

Uncommon factors leading to a crisis include:

  • Sexual intercourse
  • Defecation (having a bowel movement)
  • During pregnancy, movement of the baby or uterine contractions
  • Many medications, such as glucocorticoids (drugs that fight inflammation), painkillers (morphine), several types of antidepressants, some medications that are used for nausea.

In general, emotional stress does not cause a crisis.

Uncommon or Rare Symptoms

Uncommon symptoms may occur when a pheochromocytoma secretes hormones other than epinephrine or norepinephrine (the hormones responsible for the fight-or-flight response), with the symptoms related to the proteins or hormones that are secreted.

Some of these can include:

  • Muscle cramps due to high blood calcium levels (hypercalcemia) when a tumor releases a parathyroid type of hormone
  • Fever (due to the release of the immune protein interleukin 6)
  • A moon-shaped face, weight gain, and varicose veins (Cushing's syndrome) when a tumor releases adrenocorticotropic hormone (ACTH)
  • A ruddy complexion and elevated red blood cell count (due to the secretion of erythropoetin, a hormone in the kidneys that increases the rate of red blood cell production)

Complications

Complications can occur due to both the chronic and acute release of catecholamines into the bloodstream from the tumor and may affect any organ system.

Heart complications are most common, affecting up to one-third of people with pheochromocytoma. These complications may include:

  • Hypertensive crisis: Severely elevated blood pressure can lead to many of the complications below such as abnormal heart rhythms, heart attacks, stroke, or death.
  • Arrhythmias: Abnormal heart rhythms (many types) can be caused by either the acute or chronic release of catecholamines.
  • Myocarditis: Myocarditis is inflammation of the heart.
  • Cardiomyopathy: Sometimes called catecholamine cardiomyopathy, this leads to heart failure and pulmonary edema.
  • Broken heart syndrome: Broken heart syndrome (Takatsubo syndrome) or stress cardiomyopathy usually comes on suddenly and can closely resemble a heart attack. Unlike a heart attack, however, the syndrome is reversible if diagnosed early. With a pheochromocytoma, the syndrome is usually preceded by either physical or emotional stress.

Of note, a pheochromocytoma may cause heart damage even if it does not trigger any symptoms. The release of catecholamines from the tumor can also affect the brain and other organs, increasing the risk of stroke, neurological symptoms such as confusion and seizures, and kidney failure.

If a pheochromocytoma remains undiagnosed, the effects can damage many organs, leading to multiorgan failure.

When to See a Doctor

There are a number of symptoms caused by a pheochromocytoma that should make people seek emergency care. These include:

  • Severe high blood pressure (for those who monitor blood pressure at home)
  • Chest pain
  • Shortness of breath
  • Weakness or numbness of one side of the body
  • Speech difficulties
  • Fainting/light-headeness

Summary

The most common symptom of a pheochromocytoma is high blood pressure. High blood pressure may be chronic (ongoing) or occur in episodes called paroxysms. Other symptoms may include heart palpitations, headaches, sweating, anxiety, and a general sense of impending doom.

A Word From Verywell

The signs and symptoms of a pheochromocytoma overlap with many conditions, but often stand out due to their severity, as well as their tendency to occur in episodes, or paroxysms. While high blood pressure is very common, if it occurs along with palpitations, headaches, sweating, tremors, anxiety, and a feeling of impending doom, it's important to talk to your healthcare provider.

Fortunately, either blood or urine testing can usually rule out or confirm a diagnosis of pheochromocytoma, even in those who have a hereditary syndrome associated with the disease.

The potential complications of a pheochromocytoma are also anxiety provoking, but many of these can be avoided with prompt evaluation and treatment of any symptoms you have.

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8 Sources
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