CLINICAL PRESENTATIONPheochromocytoma is usually suggested by the history in a

symptomatic patient, discovery of a lipid-poor incidental adrenal mass, or the

family history in a patient with familial disease. In one report of 107 patients,
the average age at diagnosis was 47 years, and the average tumor size was 4.9 cm
[5].
Symptoms and signs���Symptoms are present in approximately 50 percent of patients
with pheochromocytoma, and when present, they are typically paroxysmal.
Classic triad���The classic triad of symptoms in patients with a pheochromocytoma
consists of episodic headache, sweating, and tachycardia [1,7]. Approximately one-
half have paroxysmal hypertension; most of the rest have either primary
hypertension (formerly called "essential" hypertension) or normal blood pressure.
Most patients with pheochromocytoma do�not�have the three classic symptoms [8,9],
and patients with primary hypertension may have paroxysmal symptoms [10].
?Sustained or paroxysmal hypertension is the most common sign of pheochromocytoma,
but approximately 5 to 15 percent of patients present with normal blood pressure.
The frequency of normotension is higher in patients with adrenal incidentaloma or
in those undergoing periodic screening for familial pheochromocytoma [7,11,12].
?Headache, which may be mild or severe and variable in duration, occurs in up to 90
percent of symptomatic patients [12].
?Generalized sweating occurs in up to 60 to 70 percent of symptomatic patients.
Other symptoms include forceful palpitations, tremor, pallor, dyspnea, generalized
weakness, and panic attack-type symptoms (particularly in pheochromocytomas that
produce epinephrine) [13].
?On rare occasions, patients present with a condition termed pheochromocytoma
crisis, or pheochromocytoma multisystem crisis. These individuals may have either
hypertension or hypotension, hyperthermia (temperature >40�C), mental status
changes, and other organ dysfunction [14].