Phaeochromocytoma
Phaeochromocytoma is a rare catecholamine‑secreting neuroendocrine tumour, most commonly arising from adrenal medullary chromaffin cells. Extra‑adrenal tumours in chromaffin tissue are commonly called paragangliomas.
Although uncommon, phaeochromocytoma is an important and potentially life‑threatening cause of secondary hypertension and cardiovascular instability; timely recognition, stabilisation and specialist review are essential (NICE NG136; RCEM guidance).
Recognition and urgency
- Classic features are paroxysms of headache, palpitations and profuse sweating with labile or markedly raised blood pressure. These symptoms, especially when occurring together, should prompt same‑day specialist assessment and urgent referral (NICE NG136).
- Presentations range from an incidental adrenal mass or vague symptoms to hypertensive crisis, arrhythmia, catecholamine cardiomyopathy, myocardial ischaemia, stroke or cardiogenic shock.
- Common ED pitfalls:
- Treating tachycardia with a beta‑blocker before alpha blockade.
- Failing to monitor continuously.
- Not seeking early specialist input.
Pathophysiology
- Tumours secrete excess adrenaline and noradrenaline and their metanephrine metabolites.
- Alpha‑adrenergic vasoconstriction causes hypertension, ischaemia and intravascular volume depletion.
- Beta‑adrenergic effects produce tachycardia, arrhythmia and increased myocardial oxygen demand.
- Intermittent secretion explains paroxysmal symptoms; prolonged excess can cause catecholamine‑mediated cardiomyopathy.