76. Pheochromocytomas and the Adrenaline Rush - Approach to Pheochromocytoma

Pheochromocytomas are rare, catecholamine-secreting neuroendocrine tumors that require a systematic approach to diagnosis and management. Often termed the "great masquerader," these tumors present with a classic triad of headache, diaphoresis, and palpitations, alongside paroxysmal or resistant hypertension. Diagnosis relies on biochemical testing of plasma-free or urinary fractionated metanephrines, followed by CT imaging for localization. Because one-third of cases involve germline mutations, genetic testing is essential for prognostication and family screening. Preoperative management mandates alpha-adrenergic blockade—typically using phenoxybenzamine—to prevent intraoperative hypertensive crises, followed by beta-blockers only after alpha-blockade is established. Post-surgical care focuses on monitoring for severe hypotension and hypoglycemia due to sudden catecholamine withdrawal. Surgical resection remains the definitive treatment, though long-term monitoring for recurrence is necessary given the 6.5% to 16.5% recurrence rate.