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 like you’re running from danger. Your head throbs. You sweat through your shirt-even in a cool room. Then, just as suddenly, it stops. You feel fine again. But it happens again. And again. For months. Years. Most doctors tell you it’s anxiety. Or stress. Or migraines. But what if it’s something else? Something rare, but treatable? That’s pheochromocytoma.

What Exactly Is a Pheochromocytoma?

A pheochromocytoma is a tumor that grows in the adrenal glands-small organs sitting right on top of your kidneys. It’s not cancer in most cases, but it’s dangerous anyway. This tumor makes too much of the body’s natural stress hormones: epinephrine (adrenaline) and norepinephrine. These are the same chemicals your body releases when you’re scared or in danger. But with this tumor, they’re released out of control-even when you’re just sitting on the couch.

It’s rare. Only about 1 in 200 people with high blood pressure have it. But here’s the thing: if you have unexplained spikes in blood pressure, pounding heart, sweating, and headaches, and no clear cause, this could be it. And unlike most causes of high blood pressure, this one can be cured.

Why Does It Cause Such Extreme High Blood Pressure?

Most people with high blood pressure have numbers that creep up slowly-140/90, then 150/95, then 160/100. That’s essential hypertension. It’s common. It’s managed with pills. But pheochromocytoma is different. It causes sudden, violent spikes. Blood pressure can jump to 200/120 or even 240/130 in minutes. These aren’t gradual rises. They’re explosions.

These spikes happen in "spells"-episodes that last minutes to hours. They can be triggered by physical activity, stress, even going to the bathroom (if the tumor is in the bladder). After the spell, your blood pressure might crash. Some patients even get dizzy when they stand up. That’s because the tumor messes with your body’s natural ability to regulate blood pressure.

Three symptoms show up together in most cases: severe headaches (85-90% of patients), drenching sweats (75-80%), and a racing or pounding heartbeat (70-75%). If you have all three, especially if they come in waves, you need to get tested. Many people spend years being treated for panic attacks or migraines when the real problem is this tumor.

How Is It Diagnosed?

Doctors don’t just guess. They test. The gold standard is a 24-hour urine test for metanephrines-breakdown products of adrenaline and noradrenaline. Blood tests for plasma-free metanephrines are also used. Both are over 95% accurate. If those tests are high, you have a tumor. No question.

But here’s where things go wrong: if your levels are only slightly elevated, some doctors dismiss it. That’s a mistake. About 15-20% of cases have borderline results that still mean cancer. And if you’re young, have a family history, or have multiple symptoms, you shouldn’t be told to "just relax."

After the blood or urine test confirms it, imaging follows. CT or MRI scans show where the tumor is. But newer scans-like 68Ga-DOTATATE PET/CT-are even better. They spot tiny tumors and even metastases that older scans miss.

And here’s the critical part: all patients with pheochromocytoma should get genetic testing. Between 35% and 40% of cases are linked to inherited gene mutations-SDHB, SDHD, VHL, RET, NF1. These aren’t just about your tumor. They’re about your family. If you have an SDHB mutation, your risk of cancer spreading is much higher. Your kids might be at risk too. Genetic testing isn’t optional. It’s part of treatment.

Why Surgery Is the Only Real Cure

Unlike most high blood pressure causes, pheochromocytoma can be completely cured-with surgery. That’s right. Remove the tumor, and the hormone floods stop. Blood pressure normalizes. Medications can often be stopped.

But you can’t just go in for surgery like you would for an appendectomy. This tumor is dangerous to operate on. If the surgeon touches it before your body is properly prepared, the tumor can dump a massive wave of adrenaline into your bloodstream. That can cause a heart attack, stroke, or death.

That’s why pre-op preparation is non-negotiable. You need to take alpha-blockers-usually phenoxybenzamine-for at least 7 to 14 days before surgery. These drugs block the effects of adrenaline on your blood vessels. You also need to drink lots of fluids and eat a high-sodium diet. Why? Because your body has been in constant vasoconstriction. Your blood volume is low. You’re dehydrated. Replenishing fluids prevents dangerous drops in blood pressure during surgery.

Most surgeries today are done laparoscopically-small cuts, camera, instruments. It’s minimally invasive. Recovery is quick. Most people go home in 1-2 days. Back to work in two weeks. Success rates? Around 95% at major centers.

But there’s a catch. If both adrenal glands have tumors-or if one is removed and the other is at risk-you might need both removed. That means you’ll need to take lifelong steroid replacement: hydrocortisone and fludrocortisone. Your body won’t make its own stress hormones anymore. You’ll need to take pills every day. It’s manageable, but it’s a big change.

What Happens After Surgery?

Most people feel better fast. Blood pressure drops. Headaches disappear. Sweating stops. One patient on a support forum wrote: "My blood pressure normalized within 48 hours. I was off all meds in three weeks." That’s the dream.

But not everyone has a smooth recovery. About 12% report chronic fatigue lasting six months or longer. Some develop adrenal insufficiency if both glands were removed. Others have lingering anxiety-after years of being told they were "just stressed," it takes time to unlearn that belief.

Long-term follow-up is key. Even if the tumor was benign and fully removed, you need annual blood tests. About 10% of pheochromocytomas come back. If you have an SDHB mutation, your risk of new tumors or cancer spreading is higher. You’ll need yearly whole-body MRIs.

How Is It Different From Other Causes of High Blood Pressure?

Essential hypertension? That’s the kind you get from aging, salt, weight, or genetics. It’s steady. It doesn’t come and go. You don’t sweat buckets or get pounding headaches out of nowhere.

Renal artery stenosis? That’s a narrowed kidney artery. It causes high blood pressure, but not the triad of symptoms. Primary aldosteronism? That’s too much aldosterone. It causes low potassium, muscle cramps, not sweating or palpitations.

Even panic disorder can mimic pheochromocytoma. But panic attacks don’t cause sustained high metanephrine levels. Blood tests make the difference. And here’s the kicker: if you have pheochromocytoma and you’re treated for panic disorder, you’re not getting better. You’re just being misdiagnosed.

The average time from first symptom to diagnosis? Over three years. One in four people are initially told they have anxiety. That’s unacceptable. If your symptoms are episodic, severe, and include the triad-get tested.

What’s New in Treatment?

For metastatic cases-where the cancer has spread-new treatments are emerging. Peptide receptor radionuclide therapy (PRRT) uses radioactive molecules to target tumor cells. Early results show a 65% response rate. Drugs like Belzutifan, originally for kidney cancer, are now being tested in VHL-related pheochromocytoma. Liquid biopsies to detect tumor DNA in blood are in development. These could mean earlier detection and less invasive monitoring.

But the biggest change? The shift in guidelines. The NCCN now says: test everyone for SDHB, even if you have no family history. That’s because 25% of "sporadic" cases have hidden mutations. That changes everything-your treatment, your family’s screening, your long-term risk.

What Should You Do If You Suspect This?

If you have unexplained spells of:

• Severe headaches
• Profuse sweating
• Heart pounding or racing

-and you’ve been told it’s stress, anxiety, or migraines-ask your doctor for a plasma-free metanephrine test. Don’t wait. Don’t accept "it’s probably nothing." This tumor is rare, but it’s curable. And the longer it goes undiagnosed, the more damage it can do to your heart, brain, and kidneys.

Find an endocrinologist who specializes in adrenal disorders. Ask about genetic testing. If surgery is recommended, go to a center that does at least 20 adrenal surgeries a year. Experience matters. Complication rates drop dramatically at high-volume centers.

This isn’t about fear. It’s about knowing. You don’t have to live with unexplained, terrifying symptoms. There’s a name for it. There’s a test. And there’s a cure.