Pheochromocytomas: Adrenal Gland Tumors
Headaches, Anxiety, Nervousness, and Hypertension
Pheochromocytomas are tumors of the adrenal gland that produce excess adrenaline. Pheochromocytomas arise from the central portion of the adrenal gland, which is called the adrenal medulla. The adrenal medulla is responsible for the normal production of adrenaline, which our body requires to help maintain blood pressure and to help cope with stressful situations. A tumor that arises from the adrenal medulla and overproduces adrenaline can be a deadly tumor because of the severe elevation in blood pressure it causes.
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The classic symptoms of pheochromocytomas (or pheos) are those attributable to excess adrenaline production. Often these patients will have recurring episodes of sweating, headache, and a feeling of high anxiety.
The following symptoms are listed from the most common to the least common:
- Headaches (severe)
- Excess sweating (generalized)
- Racing heart (tachycardia and palpitations)
- Anxiety and nervousness
- Nervous shaking (tremors)
- Pain in the lower chest or upper abdomen
- Nausea (with or without vomiting)
- Weight loss
- Heat intolerance
- Patients with very difficult-to-control hypertension
- Patients requiring more than 4 blood pressure medications
- Patients with onset of hypertension before the age of 35
- Patients with onset of hypertension after the age of 60
- Patients with signs or symptoms of pheochromocytoma
The diagnosis of pheochromocytoma hinges on the treating physician entertaining the diagnosis in the first place. Making the diagnosis is usually straightforward by performing the following tests:
- 24-hour urinary catacholamines and metanephrines. This test is designed to measure production of the different types of adrenaline compounds that the adrenal glands make. Since the body gets rid of these hormones in the urine, we simply collect a patient's urine for 24 hours to determine if they are over-produced.
This test measures different types of adrenaline (epinephrine, norepinephrine, dopamine), as well as the breakdown products of these compounds that the liver and kidney have degraded. Since these compounds are concentrated in the urine, this test is very good at making the diagnosis of pheochromocytoma.
- Serum catacholamines. This test measures adrenaline compounds in the blood. It is not as sensitive a test for pheochromocytoma as the 24-hour urine test (sometimes the urine test will be positive and the blood test will be negative), but it still can give important information if it shows elevated adrenaline levels.
There are 4 primary x-ray tests to examine the adrenal glands (and the rest of the abdomen) for the presence of a pheo. Some are better than others and are therefore used routinely, while one or 2 are used infrequently, yet can yield important information when positive.
To learn more, read our article about x-ray tests for adrenal gland tumors.
All pheochromocytomas should be removed surgically. The vast majority of patients can be treated with the new technique of minimally invasive laparoscopic adrenalectomy. This is now the preferred method for removing pheochromocytomas and is available in most hospitals in the US.
If you would like to learn more about pheochromocytomas, please read our article entitled Pheochromocytoma: The Ten-Percent Tumor.