Clinical features

All ages and races can be affected. The peak incidence is in the third and fourth decades of life. Men and women are equally affected.

Hypertension is the usual presenting feature. This may be sustained or paroxysmal with intervening periods of normotension.

Other symptoms related to catecholamine excess may present acutely as a hypertensive crisis, with features such as:

• headache
• palpitations
• tachycardia
• sweating
• anxiety
• panic attacks
• tremor
• nausea and vomiting
• fever

Virtually any stress can precipitate an attack, for example, exercise, emotion, postural changes, diagnostic procedures, or surgery. Occasionally, attacks occur spontaneously. Rarely, they are fatal.

Patients may show typical cardiovascular, cerebrovascular, and renal effects of prolonged hypertension, such as congestive heart failure with pulmonary oedema.

The diagnosis of phaeochromocytoma should be suspected:

• in any hypertensive with orthostatic hypotension and tachycardia
• in any hypertensive whose symptoms respond poorly to anti-hypertensive treatment
• in any patient whose blood pressure fluctuates widely
• in any hypertensive with cafe au lait spots