The symptoms of adrenal pheochromocytoma (“pheo” for short) can be variable, and often missed by doctors for years and decades. Some people with pheos have all of these symptoms, but most have only one or a few symptoms.

The top 5 symptoms of pheochromocytoma are:

1. High blood pressure (hypertension)
2. Headache
3. Racing heartbeat (tachycardia)
4. Sweating
5. Anxiety

All symptoms of a pheochromocytoma are due to the very toxic effects of too much adrenaline hormones (catecholamines). Here, we will discuss in detail what the most common symptoms of adrenal pheochromocytoma are so you can make sure that you do not have one.

Symptoms from a pheochromocytoma are often characterized by paroxysm (“spells”). This means patients develop symptoms from the pheo during an attack, a “spell”, which often last 5 to 20 minutes. The typical spell is associated with very high blood, headache, palpitations (heart racing), and sweating. Chest or abdominal pain is also common as is a sense of impending doom. The patient turning pale is usual although sometimes flushing may occur. These spells (paroxysms) typically last 5 min to an hour but occasionally last even longer. Not all paroxysms are typical, and many variations are seen.

You can read about all the various other symptoms of pheo here: https://www.adrenal.com/pheochromocytoma/pheochromocytoma-symptoms

1) High Blood Pressure as a Symptom of Adrenal Pheochromocytoma

High blood pressure is the most common symptom of pheochromocytoma. Up to 90% of all patients with a pheo have high blood pressure, also known as hypertension. It should be noted that not all patients have high blood pressure. Also, many patients have normal blood pressure except when they have a spell. Their blood pressure goes really high and sometimes dangerously high during the attack, but then normalizes. If you don’t measure the blood pressure during an attack you won’t know the blood pressure is high. About half of all patients have hypertension that is “sustained”; meaning they have high blood pressure at all times. The remainder have normal blood pressure in between attacks, and the blood pressure only goes up during an attack. About 10% have no high blood pressure.

All patients with the below criteria of high blood pressure (hypertension) needs to be tested (via a blood or urine lab test) for a pheochromocytoma:

• Hypertension at a young age (< 50 years of age)
• Hypertension that is episodic (paroxysmal). This means that you can have episodes were your blood pressure runs very high but can be normal when you do not experience these “spells”.
• Resistant hypertension (this means poor response to blood pressure medications)
• Hypertension requiring many medications (sometimes 2-3 or more blood pressure pills!)
• A family history of hypertension

• An incidentally discovered adrenal mass on imaging (usually a CT scan)

Please note that high blood pressure is a symptom for pheochromocytomas, but it can be a symptom of other endocrine tumors also. For instance, parathyroid tumors and primary hyperparathyroidism cause high blood pressure. Read more about parathyroid tumors, parathyroid adenomas, and primary hyperparathyroidism here: https://www.parathyroid.com/

Certain types of thyroid disease such as thyroid nodules, hyperthyroidism, Graves’ disease (https://www.thyroidcancer.com/graves-disease), and toxic goiter can all cause high blood pressure. Read more about thyroid diseases causing high blood pressure here: https://www.thyroidcancer.com/

2) Headache Symptoms in Adrenal Pheochromocytoma

Headache is a very common symptom of pheochromocytoma. This occurs especially during the spell and often goes together with a very high blood pressure. This type of headache can be mistaken for other types of headaches such as migraines.

3) Racing heart Symptoms in Adrenal Pheochromocytoma

A racing heart or heart palpitations, also known as tachycardia, is also very common symptom in pheochromocytoma. The patient will feel this as the heart is bouncing very hard and almost ready to jump out of the chest. This is very similar to the sensation one would experience when one is very scared or upset. This symptom is due to the fight or flight response. The increase heart rate and the blood pressure are due to the very high levels of adrenaline hormones (catecholamines). If a pheo is untreated the strain on the heart can lead to heart failure. Heart failure is very dangerous symptom and is the leading cause of death from pheochromocytoma. This is due to the very toxic effects of the hormones causing cardiac hypertrophy (the heart grows too big, and ineffective).

Certain types of thyroid disease such as thyroid nodules, hyperthyroidism, Graves’ disease (https://www.thyroidcancer.com/graves-disease), and toxic goiter can all cause heart palpitations, also known as tachycardia. Read more about thyroid diseases causing high blood pressure here: https://www.thyroidcancer.com/

4) Sweating as a symptom in Adrenal Pheochromocytoma

The sweating is due to the increase in heat production that is stimulated by the adrenaline hormones. The sweating is not due to a fever but rather this is a normal response to way too much adrenaline hormones (catecholamines).

5) Anxiety and other brain symptoms in Adrenal Pheochromocytoma

The very toxic effects of too much adrenaline hormone causes a lot of effects on our brain. Patients often develop significant anxiety as well as an impending sense of doom. This symptom can be very scary. A sense of impending doom is a feeling of dread, terror, and worry that something terrible is going to happen; for example, that the world may end or that you may die. Again, other hormones than adrenaline can cause anxiety, depression, brain fog and similar symptoms affecting our brain, and thought processes. Too much parathyroid hormone from a parathyroid tumor causing primary hyperparathyroidism can cause these symptoms and you can review this here. https://www.parathyroid.com/

Similarly, too much thyroid hormones from thyroid nodules, hyperthyroidism, Graves’ disease (https://www.thyroidcancer.com/graves-disease),, and toxic goiter can all cause anxiety. Read more about thyroid diseases causing anxiety, depression, and brain fog here: https://www.thyroidcancer.com/

Case vignette

Every single week I talk to and see patients with pheochromocytoma that doctors, hospitals, and the medical system have failed to diagnose for years. Like this sweet 76-year-old lady, they often have had symptoms of an adrenal pheo for decades. She had had high blood pressure requiring 3 medications (Propranolol, Amlodipine, and Losartan). She had heart palpitations, anxiety, depression, diabetes, as well as tremors. All very typical symptoms of pheochromocytoma. Going through her history it was obvious that she had had a pheochromocytoma for years and decades. Over time it grew to the size of a large grapefruit. Fortunately, once we diagnosed her, we got her swiftly cured by removing the adrenal pheochromocytoma. She now feels tremendous, and her high blood pressure is gone.

You can review her CT scans in these short videos.

Figure 1: The common symptoms of pheochromocytoma are summarized here

To learn more about our center specializing in adrenal pheochromocytoma, go here: https://www.adrenal.com/about