Pheochromocytoma

Pheochromocytoma is a rare tumor that develops from chromaffin cells in the adrenal medulla and over?produces catecholamines—mainly epinephrine and norepinephrine—which regulate heart rate, blood pressure, and the body’s stress response. Although most pheochromocytomas are benign and often unilateral, a small fraction are malignant or extra?adrenal (paragangliomas), and some occur in hereditary syndromes such as MEN2, von Hippel?Lindau, or neurofibromatosis?1.

The classic triad of symptoms includes episodes of severe headache, intense sweating, and a pounding or fast heartbeat, often accompanied by high blood pressure that may fluctuate between very high and normal levels. Patients frequently report anxiety, trembling, shortness of breath, pale skin, and a sense of impending doom, mimicking panic attacks. Less common features include chest or abdominal pain, nausea, weight loss, and hyperglycemia due to catecholamine?induced metabolic effects.

Diagnosis involves measuring plasma or urinary metanephrines and catecholamines, followed by adrenal imaging (CT/MRI) and genetic testing when hereditary disease is suspected. Management begins with alpha? and beta?adrenergic blockade to control blood pressure, followed by laparoscopic adrenalectomy, which is curative in most localized cases. For malignant or metastatic disease, treatment may include chemotherapy, targeted therapy, or radiation, with close long?term surveillance.