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Pheochromocytoma, Emergency Medicine

Reviewed 06/2017



  • Pheochromocytoma (pheo) is a catecholamine-producing tumor arising from the chromaffin tissues of the sympathetic nervous system.

  • Origin from the adrenal medulla or sympathetic gangli...


Signs and Symptoms


  • Hypertension, moderate to severe, refractory to treatment:

    • 40%: Paroxysms with normal BP between episodes

    • 30%: Sustained hypertension with paroxysms

    • 30%: Sustained hype...



  • IV access, oxygen

  • Continuous cardiac/BP monitoring

  • Nitroglycerin 0.4 mg SL for chest pain and HTN

Ed Treatment/Procedures

Management of Hypertensive Paroxysm



Admission Criteria

  • Suspicion of pheo in an ill or toxic patient with labile swings in BP

  • Hypertensive urgency or crisis

  • Cardiac arrhythmias

  • End organ compromise: Congestive heart fail...

Pearls and Pitfalls

  • Paroxysms of severe hypertension, headache, intense diaphoresis, and palpitations comprise a tetrad very suggestive of pheo.

  • Pallor and sweating, not flushing, is typical of pheo cr...

Additional Reading

  • Anderson  NE, Chung  K, Willoughby  E, et al. Neurologic manifestations of phaeochromocytomas and secretory paragangliomas: A reappraisal. J Neurol Neurosurg Psychiatry.  2013;...



  • 194.0 Malignant neoplasm of adrenal gland

  • 227.0 Benign neoplasm of adrenal gland


  • C74.10 Malignant neoplasm of medulla of unspecified adrenal gland

  • C74.12 Malignant neoplasm of medulla of l...

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