In pheochromocytoma, there is a tumor (often benign) of the adrenal medulla that leads to production of excessive amounts of epinephrine and norepinephrine (catecholamines). The sympathetic nervous system may be activated, evidenced by hypertension accompanied by headache, diaphoresis, and palpitation. If untreated, pheochromocytoma is potentially fatal.

The excessive secretion of one or more catecholamine hormones, such as epinephrine or norepinephrine, can cause the classic presentation of pheochromocytoma:

• Hypertension, persistent or episodic
• Headache, tremor, and nervousness
• Hyperglycemia
• Heartbeat increase (tachycardia), palpitation, dyspnea, and vertigo
• Sweating (diaphoresis), pallor, and warmth
• Polyuria, nausea, vomiting, and abdominal pain

1. Manage an acute hypertensive crisis by administering medication to normalize blood pressure. Remind patients on antihypertensives, such as propranolol (Inderal), to get up slowly so as to prevent postural hypotension, and not to stop the medication abruptly or take over-the-counter cold medications (stimulants) without their physician's approval.
2. Check blood pressure as often as indicated to detect transient or episodic blood pressure spikes, and to help monitor the effectiveness of therapy.
3. Schedule care to allow needed undisturbed rest. Ensure a quiet, cool environment because this condition may cause profuse sweating. Maintain the patient's nutritional status.
4. Nurses may assist in pheochromocytoma case finding; when patients do not respond to conventional hypertension treatments, but have episodic headache, palpitations, and sweating, suspicion for this condition may be raised. Ensure the reliability of urine catecholamine measurements to help establish the diagnosis.

Before initiating 24-hour urine collection, remind the patient to avoid certain medications and foods high in vanillin as per the lab's requirements (e.g., chocolate, banana, caffeine).

Check blood pressure frequently or every few minutes, as indicated, especially after surgery or administering potent medications. Drastic fluctuations in blood pressure often occur after adrenal-gland manipulation or surgery. Corticosteroids replacement may become necessary in some patients.