pheochromocytoma
Deep inside each adrenal gland sits a core, the adrenal medulla, that makes the fight-or-flight chemicals adrenaline and its relatives. A pheochromocytoma is a tumor of those cells that pumps out these stress hormones on its own, without the danger that would normally call for them — like a fire alarm that goes off at random with no fire in sight.
Because the catecholamines it releases drive the cardiovascular system, the hallmark is high blood pressure, often in striking surges. Classic spells bring pounding headache, drenching sweat, and a racing, forceful heartbeat that come and go as the tumor releases its hormone in bursts. Between attacks a person may feel fairly normal, which can make the diagnosis elusive.
Pheochromocytoma is uncommon but important to find, because the surges can be life-threatening and because surgery is dangerous if the hormone effects are not blocked first — manipulating the tumor can trigger a massive release. So treatment begins with medications that shield the body from the catecholamines, allowing the tumor to be removed safely afterward. A notable share are linked to inherited syndromes, so a diagnosis often prompts genetic evaluation.
A 35-year-old with episodes of pounding headache, sweating, and blood pressure spikes is found to have a pheochromocytoma; she is started on blocking medication for weeks before the adrenal tumor is safely removed.
Block the hormone first, then operate.
A teaching rule of thumb is the rule of tens: roughly a tenth are outside the adrenal gland, a tenth occur on both sides, a tenth are malignant, and a notable share are inherited — figures that are approximate but capture the tumor's variability.