Clinical Features and Presentation

The presenting features of phaeochromocytoma are very wide and varied.  For this reason it is referred to as the great mimic.

Differential diagnosis of Phaeochromocytoma [6,8].

  • Hyperthyroidism
  • Carcinoid
  • Hypoglycaemia
  • Medullary thyroid carcinoma
  • Mastocytosis
  • Menopausal syndrome
  • Heart failure
  • Arrythmias
  • Ischaemic heart disease
  • Baroreflex failure
  • Renovascular hypertension
  • Migraine
  • Stroke
  • Diencephalic epilepsia
  • Meningioma
  • Postural orthostatic tachycardia syndrome
  • Essential hypertension
  • Alcohol withdrawal
  • Pre-eclampsia
  • Porphyria
  • Panic disorder or anxiety
  • Factitious disorders
  • Drug treatment
  • Illegal drug use

Hypertension is a common presenting feature with systolic BP >220 mmHg or diastolic above 120 mmHg being generally accepted limiting values.  Hypertension is frequently associated with profound tachycardia, pallor and a feeling of anxiety or impending doom [9].  These symptoms are often paroxysmal and can occur many times a month or just once with a single fatal presentation. 

Precipitants can include abdominal compression, anaesthesia, opiates, dopamine antagonists, cold medications, radiographic contrast media, catecholamine reuptake inhibitors and childbirth [6,9].

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