Symptoms of Pheochromocytoma (Pheo) of the Adrenal Gland

What are the Symptoms of Pheochromocytomas?

Signs and symptoms of Pheochromocytoma and Paraganglioma. The symptoms can be very variable, and some patients are asymptomatic.

The classic symptoms of pheochromocytomas (or pheos) are caused by the excess adrenaline-type hormones produced by the adrenal gland tumor. The lists below show the classic symptoms, but some patients have symptoms only on occasion, and some have none at all: a growing share of pheochromocytomas are now found by accident on a scan done for another reason, or through family genetic screening. Pheochromocytoma has also been called the great “mimicker” because its symptoms can mimic those of many other diseases, including anxiety and panic attacks. Patients who do have symptoms from their pheo often have paroxysms (“spells” of symptoms) and feel just fine at other times.

This List Summarizes a Typical Paroxysm “Spell” of Symptoms From a Pheochromocytoma

• Headache, sweating, and palpitations
• Very high BP (frequently with tachycardia)
• Chest or abdominal pain
• Pallor/flush
• Apprehension (sense of impending doom)
• Duration (5 min to an hour or longer)
• Spells may be spontaneous or precipitated by change in body position, anxiety, medications (e.g., metoclopramide, anesthetic agents), and maneuvers that increase intraabdominal pressure (e.g. going to the bathroom).

Other Typical Signs and Symptoms of Pheochromocytoma Include:

• 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
• Recent onset of hypertension
• Severe hypertension or a hypertensive emergency
• Blood pressure that swings widely (marked blood pressure lability)
• Carbohydrate intolerance or new-onset diabetes mellitus
• Orthostatic hypotension in the untreated state (feeling faint when you stand up)
• Unexpected, prominent changes in blood pressure (up or down) in response to drugs or medical procedures

An adrenal mass found on a scan, or a family history of pheochromocytoma or paraganglioma, is also a reason to be tested, even if you have none of these symptoms. In our center's published series, about 15% of non-hereditary pheochromocytomas were “silent”: the patients had normal blood pressure and the tumor was found by accident. Testing is simple and is explained on our blood and urine tests for pheochromocytoma page.

Read more about symptoms of pheochromocytoma on our adrenal surgery blog

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Complications and Quality-of-Life Issues with Untreated Pheochromocytoma

Why are pheochromocytomas (and paragangliomas) so important, and why are we so eager to get patients treated? The reason is the serious effects that high levels of adrenaline-type hormones have on the body over time (this is called target organ damage). It also matters because many pheochromocytomas go undiagnosed for a long time: it is common that patients, by the time they see Dr. Carling, have had symptoms for years or even decades. Only a few of every hundred adrenal masses turn out to be a pheochromocytoma, but because missing one is dangerous, every adrenal mass should be tested. For most patients the tumor can be removed through a short, minimally invasive operation, followed by lifelong yearly follow-up. Too much adrenaline-type hormone affects your entire body, especially the heart, blood vessels, kidneys, and central nervous system (the brain).

High blood pressure is the most common clinical feature of pheochromocytoma. The traditional estimate was that 90% of pheochromocytoma patients are hypertensive. Today the share with normal blood pressure is higher, because more tumors are found incidentally during imaging for an unrelated problem or through genetic screening of families with hereditary pheochromocytoma and paraganglioma.

High blood pressure in pheochromocytomas and paragangliomas takes several forms:

• Sustained high blood pressure, with or without sudden surges (crises) on top of it. This is the most common pattern.
• Paroxysmal high blood pressure: surges during spells, with normal blood pressure between attacks.
• No high blood pressure at all (tumors discovered incidentally or through screening).

It is noteworthy that many pheochromocytoma and paraganglioma patients with sustained high blood pressure do not have discrete spells. This is the group that masquerades as ordinary (essential) hypertension. The high blood pressure, whether sustained or episodic, puts the patient at great risk of a stroke.

Chest pain may reflect poor blood flow to the heart (cardiac ischemia) from either an increase in demand or a decrease in supply of blood and oxygen to the heart. This puts you at risk of heart damage (heart attacks, heart arrhythmias, and sudden death).

Congestive heart failure in patients with pheochromocytomas and paragangliomas may occur because the adrenaline-type hormones weaken the heart muscle (catecholamine cardiomyopathy) or cause cardiac hypertrophy (the heart muscle grows too thick and works poorly). The heart often recovers after the tumor is removed.

Abdominal pain, which may be associated with nausea and vomiting, sometimes reflects bleeding within the tumor (pheochromocytomas and paragangliomas can spontaneously start to bleed).

Sweating reflects the increase in heat production stimulated by adrenaline-type hormones.

Weight loss in patients with pheochromocytomas and paragangliomas is another consequence of the increased metabolic rate due to adrenaline-type hormones.

Orthostatic hypotension (the medical term for a drop in blood pressure when you stand up, often causing dizziness) is an important manifestation of pheochromocytomas and paragangliomas. In fact, in an untreated hypertensive patient, a prominent fall in blood pressure on standing (20/10 mmHg) should raise the suspicion of pheochromocytoma.

Rhabdomyolysis (breakdown of your muscles) and ischemic colitis (part of the large bowel is damaged because it does not get enough blood) are rare complications of pheochromocytomas and paragangliomas, caused by intense narrowing of the blood vessels in the skeletal muscle and colon, respectively.

Hypotension (low blood pressure) or shock is an infrequent but important manifestation of pheochromocytomas and paragangliomas, since it may be associated with significant morbidity or death.

Acute respiratory distress syndrome (ARDS) or “shock lung” is a rare but serious complication of pheochromocytomas and paragangliomas. In some cases it is the presenting manifestation; in others it develops in the wake of a particularly severe paroxysm. It is frequently associated with hypotension, presumably due to the release of adrenaline-type hormones from the tumor.

Acute abdominal catastrophe is another infrequent but well-recognized presentation. It is associated with abdominal pain, frequently shock, but sometimes with high and/or fluctuating blood pressure. The cause is usually hemorrhage into the tumor, sometimes with leakage of blood into the abdominal cavity.

When to seek emergency care: sudden severe headache, chest pain, shortness of breath, fainting, or very high blood pressure with a pounding heart needs emergency medical attention. If you are known to have a pheochromocytoma, tell the emergency team.

Last updated October 2026.

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