Symptoms of Pheochromocytoma
The classic triad of symptoms in pheochromocytoma consists of headaches, palpitations, and sweating, typically occurring in an episodic fashion, with a diagnostic specificity of 90%. 1
Primary Clinical Manifestations
Pheochromocytomas are rare catecholamine-producing tumors that present with a constellation of symptoms related to catecholamine excess:
Cardiovascular symptoms:
Neurological symptoms:
- Headaches (often severe)
- Anxiety or panic attacks
- Tremors
Autonomic symptoms:
- Episodic sweating (diaphoresis)
- Pallor
- Piloerection ("cold sweat") 1
Additional Presentations
- Paroxysmal symptoms: Episodes or "spells" of symptoms that come and go, often lasting minutes to hours 1
- BP lability: Dramatic fluctuations in blood pressure, which can be a distinguishing feature 1
- Metabolic symptoms:
- Weight loss
- Hyperglycemia
- Heat intolerance
Severe Manifestations
In severe cases, pheochromocytoma can present with:
- Cardiogenic shock 2
- Pulmonary edema 3
- Cardiomyopathy 4
- Electrical storm (multiple episodes of ventricular arrhythmias) 4
- Total circulatory collapse requiring life support 3
Clinical Patterns
The presentation of pheochromocytoma is highly variable and can mimic many other diseases 5. Key patterns include:
- Resistant hypertension: Hypertension that does not respond to standard treatment 1
- Crisis presentation: Sudden, severe hypertension with end-organ damage 3
- Incidental finding: Discovered during imaging for other reasons (adrenal incidentaloma) 1
Diagnostic Considerations
It's important to note that:
- The average delay between initial symptoms and diagnosis is approximately 3 years 1
- 55% of pheochromocytomas contribute to deaths and are not suspected in 75% of cases based on autopsy studies 1
- Approximately 30% of pheochromocytomas are hereditary 1
Clinical Pitfalls
- Symptoms can be intermittent, making diagnosis challenging
- Many cases are missed entirely and only discovered at autopsy 1
- The classic triad may not be present in all patients
- Symptoms can be triggered by certain medications, physical activity, or procedures
- Pheochromocytoma should be considered in any patient with unexplained paroxysmal symptoms, especially when associated with hypertension
Early recognition of these symptoms is crucial as pheochromocytoma can be life-threatening if undiagnosed or improperly managed, but it is typically curable with appropriate treatment 6.