Among the clinical manifestations of pheochromocytoma, the first one is the most obvious!

Pheochromocytoma is a common disease in urology and a common adrenal disease. The most typical manifestation of this disease is high blood pressure, which is usually sudden and accompanied by severe headaches, palpitations, and arrhythmias. In addition, this disease can also cause symptoms of low blood pressure.

(1) Hypertension : It is the main and characteristic manifestation of this disease and may occur intermittently or continuously. Typical paroxysmal attacks are often manifested by a sudden increase in blood pressure, which may reach 200-300/130-180 mmHg, accompanied by severe headache, profuse sweating, palpitations, tachycardia, arrhythmia, a sense of urgency, pain, anxiety, fear or a sense of impending death in the precordial area and upper abdomen, pale skin, nausea, vomiting, abdominal or chest pain, blurred vision, diplopia. Severe cases may lead to acute left heart failure or cardiovascular and cerebrovascular accidents. After the attack ends, symptoms of vagus nerve excitement such as flushing of the face and skin all over the body, fever, drooling, pupil constriction, and increased urine volume may appear. Paroxysmal seizures can be triggered by emotional excitement, changes in body position, trauma, enema, urination, defecation, abdominal palpation, preoperative anesthesia, or certain drugs (such as histamine, guanethidine, glucagon, dopamine antagonists, amphetamines, catecholamine reuptake blockers, and monoamine oxidase inhibitors). The duration of seizures varies, from as short as a few seconds to as long as several hours or more. The frequency of attacks varies, ranging from several times a day to once every few months. As the disease progresses, the attacks become more frequent and longer. It is generally not well responded to commonly used antihypertensive drugs, but is effective to α-adrenergic receptor antagonists and calcium channel blockers. If hypertension is accompanied by the above-mentioned sympathetic nerve overexcitation, high metabolism, headache, anxiety, irritability, orthostatic hypotension or large blood pressure fluctuations, especially when occurring in children or young people, this disease should be highly suspected. A small number of patients (mostly children or young people) may show rapid progression of the disease, with acute malignant hypertension, diastolic blood pressure higher than 130 mmHg, severe fundus damage, optic atrophy and blindness in a short period of time, and azotemia, heart failure or hypertensive encephalopathy may occur.

(2) Hypotension and shock : This disease may also cause hypotension or postural hypotension, or even shock or alternating hypertension and hypotension.

(3) Heart: Large amounts of catecholamines can cause catecholamine heart disease, which may result in arrhythmias such as premature beats, paroxysmal tachycardia, and ventricular fibrillation. In some cases, it may cause myocardial damage such as myocardial degeneration, necrosis, and inflammatory changes, leading to heart failure. Long-term, persistent hypertension can lead to left ventricular hypertrophy, cardiac enlargement and heart failure.