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Last reviewed: 5 Nov 2023
Last updated: 17 Oct 2023



History and exam

Key diagnostic factors

  • headache
  • palpitations
  • diaphoresis
  • hypertension
  • hypertensive retinopathy
  • pallor
  • impaired glucose tolerance/diabetes mellitus
  • family history of endocrine disorders
  • history of prior pheochromocytoma
  • tachyarrhythmias and myocardial infarction
  • panic attacks or a "sense of doom"
More key diagnostic factors

Other diagnostic factors

  • orthostatic hypotension
  • hypercalcemia
  • Cushing syndrome
  • diarrhea
  • fever
  • papilledema
  • 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
  • CT scan of the abdomen and pelvis
  • MRI of the abdomen and pelvis
  • I-123 metaiodobenzylguanidine (MIBG) scintigraphy
  • 18F-fluoro-2 deoxy-D-glucose (18F-FDG) positron emission tomography (PET) or FDG, 18-F-dihydroxyphenylalanine (DOPA), Ga-68-DOTATATE
More investigations to consider

Treatment algorithm


hypertensive crisis


without hypertensive crisis



Bridget Sinnott, MD
Bridget Sinnott

Professor of Medicine

Medical College of Georgia




BS declares that she has no competing interests.


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




BAH declares that she has no competing interests.

  • Pheochromocytoma images
  • Differentials

    • Anxiety and panic attacks
    • Essential or intractable hypertension
    • Hyperthyroidism
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
    • American Association of Endocrine Surgeons guidelines for adrenalectomy
    More Guidelines
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