Pheochromocytoma

• Alternative Names

  Chromaffin tumors; Paraganglionoma

• Causes, incidence, and risk factors

  Pheochromocytoma may occur as a single tumor or as more than one growth. It usually develops in the center (medulla) of one or both adrenal glands. Sometimes this kind of tumor occurs outside the adrenal gland, usually somewhere else in the abdomen.

  Less than 10% of pheochromocytomas are cancerous (malignant), meaning they have the potential to spread to other parts of the body.

  The tumors may occur at any age, but they are most common from early to mid-adulthood. About 10% of the time there is a family history of the disease.

• Symptoms
  • Abdominal pain
  • Chest pain
  • Flushing
  • Increased appetite
  • Irritability
  • Nervousness
  • Palpitations
  • Rapid heart rate
  • Severe headache
  • Sweating
  • Weight loss

  Other symptoms that can occur with this disease:

  • Hand tremor
  • High blood pressure
  • Sleeping difficulty

  There may be an attack of the symptoms listed above (paroxysm). It may occur at unpredictable intervals (sporadic). The paroxysms may increase in frequency, length, and severity as the tumor grows.

• Signs and tests

  An examination of vital signs can show high blood pressure, rapid heart rate, and fever when taken during an attack of symptoms. These signs can be normal at other times.

  Tests include:

  • Abdominal CT scan
  • Adrenal biopsy
  • Catecholamines in the blood
  • Glucose test
  • MIBG scintiscan
  • MRI of abdomen
  • Urine catecholamines
• Treatment

  Treatment involves removing the tumor with surgery. It is important to stabilize blood pressure and pulse with medication before surgery. You may need to stay in the hospital.

  After surgery, it is necessary to continually monitor all vital signs in an intensive care unit. When the tumor cannot be surgically removed, medication is needed to manage it. Radiation therapy and chemotherapy have not been effective in curing this kind of tumor.

• Expectations (prognosis)

  About 95% of patients who have noncancerous tumors that are removed with surgery are still alive after 5 years. The tumors come back in less than 10% of these patients. Release of the hormones norepinephrine and epinephrine returns to normal after surgery.

  Less than 50% of patients who have cancerous tumors that spread to the bones, liver, or lung are alive after 5 years.

• Complications

  High blood pressure may not be cured in 25% of patients after surgery. However, standard treatments can usually control high blood pressure. In about 10% of people, the tumor may return.

• Calling your health care provider

  Call your health care provider if:

  • You have symptoms of pheochromocytoma
  • You had a pheochromocytoma in the past and your symptoms return
• References

  Ferri FF. Ferri's Clinical Advisor. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2009.

Review Date: 9/4/2008

Reviewed By: Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, Washington; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.