Last reviewed: 18 Apr 2022
Last updated: 10 Dec 2019
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- headache
- palpitations
- diaphoresis
- hypertension
- hypertensive retinopathy
- pallor
- impaired glucose tolerance/diabetes mellitus
- family history of endocrine disorders
- history of prior phaeochromocytoma
- tachyarrhythmias and myocardial infarction
- panic attacks or a 'sense of doom
More key diagnostic factors
Other diagnostic factors
- orthostatic hypotension
- hypercalcaemia
- Cushing syndrome
- diarrhoea
- fever
- papilloedema
- abdominal masses
- tremors
Other diagnostic factors
Risk factors
- Multiple endocrine neoplasia (MEN) syndrome type 2A and B
- Von Hippel-Lindau (VHL) disease
- neurofibromatosis type 1 (NF1)
- succinate dehydrogenase (SDH) subunit B, C, and D gene mutations
More risk factors
Diagnostic investigations
1st investigations to order
- 24-hour urine collection for catecholamines, metanephrines, normetanephrines, and creatinine
- serum free metanephrines and normetanephrines
- plasma catecholamines
- genetic testing
More 1st investigations to order
Investigations to consider
- CBC
- serum calcium
- serum potassium
- chromogranin A
- clonidine suppression test
- MRI of the abdomen and pelvis
- CT scan of the abdomen and pelvis
- I-123 metaiodobenzylguanidine (MIBG) scintigraphy
- 18F-fluoro-2 deoxy-D-glucose (18F-FDG) positron emission tomography (PET)
More investigations to consider
Treatment algorithm
INITIAL
hypertensive crisis
ACUTE
without hypertensive crisis
Contributors
Authors
Bridget Sinnott, MD

Associate Professor of Medicine
Medical College of Georgia
Augusta
GA
Disclosures
BS declares that she has no competing interests.
Acknowledgements
Dr Bridget Sinnott would like to gratefully acknowledge Dr Sidhbh Gallagher, a previous contributor to this topic. SG declares that she has no competing interests.
Peer reviewers
Betul A. Hatipoglu, MD
Clinical Endocrinologist and Research Scientist
Department of Endocrinology, Diabetes, and Metabolism
Cleveland Clinic
Cleveland
OH
Disclosures
BAH declares that she has no competing interests.
Differentials
- Anxiety and panic attacks
- Essential or intractable hypertension
- Hyperthyroidism
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma
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