Pheochromocytoma: What It Is, How It Causes High Blood Pressure, and Why Surgery Is Often the Cure

Imagine your body flooding with adrenaline for no reason. Your heart pounds, your head throbs, you sweat buckets - all while sitting quietly at your desk. For people with pheochromocytoma, this isn’t anxiety. It’s a tumor in their adrenal gland, silently pumping out stress hormones like a broken faucet. And the worst part? Most doctors miss it.

What Exactly Is a Pheochromocytoma?

A pheochromocytoma is a rare tumor that grows in the adrenal medulla - the inner part of the adrenal glands, which sit on top of each kidney. These glands normally release small amounts of epinephrine and norepinephrine to help you react to danger - like sprinting away from a car or climbing out of a cold lake. But in pheochromocytoma, the tumor churns out massive, uncontrolled doses of these hormones. Even when you’re not scared.

It’s not cancer - at least not usually. About 90% of these tumors are benign. But that doesn’t make them harmless. The hormone surge can spike blood pressure to 200/120 mmHg or higher in seconds. That’s enough to trigger a stroke, heart attack, or even sudden death. And because symptoms come in unpredictable waves, many patients are misdiagnosed for years.

The Classic Triad: Headaches, Sweating, and Racing Heart

If you’ve ever had a panic attack, you might think this sounds familiar. But pheochromocytoma has a signature pattern: the classic triad.

• Severe headaches (85-90% of cases) - often described as "the worst headache of my life," not the dull ache of tension.
• Profuse sweating (75-80%) - drenching clothes, even in cool rooms, without physical exertion.
• Palpitations or tachycardia (70-75%) - heart racing so hard you can feel it in your throat.

These aren’t constant. They come in spells - triggered by things like lifting groceries, emotional stress, or even urinating (if the tumor is in the bladder wall). Some patients get dizzy when standing up because the body can’t regulate blood pressure properly. Others lose weight, feel nauseous, or panic for no reason.

Doctors often mistake this for anxiety, migraines, or menopause. One patient told me, "I went to seven doctors over four years. They gave me Xanax. I was told to meditate. My blood pressure hit 240/130 in the ER - and they still didn’t test for the tumor until my husband insisted."

Why It Causes Dangerous High Blood Pressure

Essential hypertension - the kind most people have - is steady. Your blood pressure is always a bit high. Pheochromocytoma is different. It’s paroxysmal: sudden, violent spikes followed by normal or even low readings.

That’s why routine blood pressure checks can miss it. A patient might show 120/80 at their annual checkup - but during a spell, their pressure rockets to 220/140. If you don’t catch those spikes, you don’t catch the tumor.

Unlike kidney disease or thyroid issues, which cause high blood pressure through other mechanisms, pheochromocytoma directly overloads the body’s stress system. The result? Blood vessels constrict, heart rate surges, and organs get pounded. Over time, this can damage the heart, kidneys, and brain.

How Doctors Diagnose It - And Why Most Get It Wrong

There’s no single test. Diagnosis starts with biochemical testing - not imaging.

The gold standard is a 24-hour urine test for fractionated metanephrines. These are breakdown products of adrenaline and noradrenaline. When the tumor leaks hormones, metanephrines pile up in the urine. This test catches 96-99% of cases. Blood tests for plasma-free metanephrines are almost as accurate.

But here’s the catch: you must prepare properly. If you’re stressed, drinking coffee, smoking, or taking certain medications (like decongestants or antidepressants), your levels can spike - and give a false positive. That’s why some patients get unnecessary scans and anxiety. Experts say up to 20% of borderline results lead to overdiagnosis.

Imaging (CT or MRI) only comes after the blood or urine test confirms something’s wrong. Even then, 10% of these tumors aren’t even on the adrenal gland - they’re elsewhere in the abdomen or chest. Those are called paragangliomas.

And here’s the biggest blind spot: genetics. Between 35-40% of pheochromocytoma cases are linked to inherited mutations - in genes like SDHB, VHL, or RET. That means if you have it, your siblings or kids might too. Yet, many doctors still skip genetic testing. The latest guidelines say: test everyone. No exceptions.

The Only Real Cure: Surgery

Unlike other causes of high blood pressure, pheochromocytoma can be cured - with surgery.

But you can’t just operate. If you remove the tumor without preparing the body, the sudden release of stored hormones can cause a catastrophic blood pressure spike during surgery - with a 30-50% risk of death.

That’s why pre-op preparation is non-negotiable:

1. Alpha-blockers - usually phenoxybenzamine - for 7-14 days. This opens up constricted blood vessels and prevents dangerous spikes.
2. High-sodium diet - 200+ mEq of salt per day. The tumor causes chronic vasoconstriction, which shrinks blood volume. You need to rehydrate to avoid shock during surgery.
3. Fluids - 2-3 liters of water daily. This supports blood pressure stability.

Once ready, most patients get a laparoscopic adrenalectomy - a minimally invasive removal of the adrenal gland. It takes 2-3 hours. Recovery? Most go home in 1-2 days. Many stop all blood pressure meds within 3 weeks.

One patient wrote: "My BP dropped to normal the day after surgery. I hadn’t felt this calm in 10 years."

What Happens After Surgery?

For most - the ones with a single, benign tumor - life returns to normal. Blood pressure stabilizes. Symptoms vanish. No more meds.

But not everyone is so lucky.

• Bilateral tumors - if both adrenal glands are removed, you lose your body’s ability to make cortisol and aldosterone. You’ll need lifelong steroid replacement: hydrocortisone and fludrocortisone.
• Malignant cases - about 10% of tumors spread. These require ongoing monitoring, targeted therapies like PRRT (peptide receptor radionuclide therapy), or even chemotherapy. Survival drops sharply - only about half live past 5 years.
• Chronic fatigue - 12% of patients report extreme tiredness for 6+ months after surgery. It’s not well understood, but it’s real.

And if you have a genetic mutation - especially SDHB - you need lifelong surveillance. Annual whole-body MRIs. Because new tumors can pop up elsewhere, even years later.

Why This Matters More Than You Think

Pheochromocytoma affects 1 in 200,000 people. That’s rare. But it’s also one of the few curable causes of high blood pressure. For every patient who goes undiagnosed, there’s a preventable stroke, heart failure, or death.

Primary care doctors might see one case in their entire career. So when a patient says, "I get these terrifying spells - sweating, heart racing, head splitting," don’t assume it’s anxiety. Don’t just prescribe a beta-blocker. Test the metanephrines.

And if you’re someone who’s been told "it’s all in your head" - but your body says otherwise - push for the test. Bring this article. Ask for a 24-hour urine metanephrine panel. It’s simple. It’s cheap. And it could save your life.