Pheochromocytoma is a very rare form of secondary hypertonia. It’s caused by catecholamine producing tumor in the adrenal glands or the sympathetic nervous system.



Headache (80%)

Palpitations / tachycardia ( 60%)

Paroxysmal tachycardia

Sweating (60%)

Pale – attacks


Weakness / tiredness



The symtoms can either be constant or come in attacks. Hypertensive crisis is often precipitated by anesthesia, but even some medications eg. tricyclic antidepressant, metoclopramide, some food and beverages and when the tumor is physically compressed can cause the crisis.


Patients with hypertonia that are difficult to treat, have a paradoxal response to beta blockers or a hypertensive reaction when given anesthetics should be screened for this diagnosis. 


If there is a strong suspicion of pheochromocytoma induced hypertonia then investigation and treatment should be made in consultation with an endocrinologist. The rest of the patients that are in the ER with symtoms compatible with pheochromocytoma should be investigated later on with these tests:

– P-Metoxynoradrenaline

– P-Metoxyadrenaline

Preferably during an attack.


If the values are pathological then one should go on with CT-adrenal glands. If the Adrenaline values are distinctive increased, the probability of localizing a tumor to the adrenal glands increases.  If the catecholamines and CT- adrenal glands does not verify the diagnosis even though there’s a strong clinical suspicion, one should consulate an endocrinologist for further investigation.



In most cases, the diagnosis are not confirmed and in these cases one should give injections or infusions of labetalol (Trandate) that in higher doses means both alfa- and beta- blockage which is important because only betablockage should not be given to these patients. Alfadil (Doxazosin) is also an alternativ, begin with 2-4 mg po.

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