To diagnose pheochromocytoma, your health care provider will likely order several tests.
These tests measure levels of adrenaline, noradrenaline or substances that are a byproduct of those hormones in your body:
- 24-hour urine test. In this test, you collect a urine sample every time you urinate during a 24-hour period. Ask for written instructions about how to store, label and return the samples.
- Blood test. A specialist will draw blood to be tested in the lab.
For both types of tests, talk with your health care provider about special preparations. For example, you may be asked not to eat for a period of time before the test (fast) or skip a medication. Don't skip a medication dose without instructions from your provider.
If the lab test results suggest the presence of a pheochromocytoma or paraganglioma, your health care provider will likely order one or more imaging tests to find a possible tumor. These tests may include:
- CT scan, a specialized X-ray technology
- MRI, which uses radio waves and a magnetic field to produce detailed images
- M-iodobenzylguanidine (MIBG) imaging, a scanning technology that can detect tiny amounts of an injected radioactive compound taken up by pheochromocytomas or paragangliomas
- Positron emission tomography (PET), a scanning technology that also can detect radioactive compounds taken up by a tumor
A tumor in an adrenal gland might be found during imaging studies done for other reasons. If that happens, your health care provider will generally order additional tests to find out more about the tumor.
Your health care provider might recommend genetic tests to determine whether a pheochromocytoma is related to an inherited disorder. Information about possible genetic factors can be important for many reasons:
- Some inherited disorders can cause multiple conditions, so test results may suggest the need to screen for other medical problems.
- Some disorders are more likely to occur again or be cancerous, so your test results may affect treatment decisions or long-term plans to monitor your health.
- Results from tests may suggest that other family members should be screened for pheochromocytoma or related conditions.
Genetic counseling can help you understand the results of your genetic testing.
The primary treatment for a pheochromocytoma is surgery to remove the tumor. Before you have surgery, your health care provider will likely prescribe specific blood pressure medications. These medications block high-adrenaline hormones to lower the risk of developing dangerously high blood pressure during surgery.
Preparations before surgery
You'll likely take medications for 7 to 10 days that help lower blood pressure before surgery. These drugs will either replace or be added to other blood pressure medications you take. You may also be encouraged to eat a high-salt diet.
Medications, such as alpha blockers, beta blockers and calcium channel blockers, keep smaller veins and arteries open and relaxed. This improves blood flow and decreases blood pressure. Some of these medications may also cause your heart to beat more slowly and with less force. This can further decrease blood pressure.
Because these medications widen the blood vessels, they cause the amount of fluid within the blood vessels to be low. This can cause dangerous drops in blood pressure with standing. A high-salt diet will draw more fluid inside the blood vessels, preventing low blood pressure during and after surgery.
Usually, the procedure for an adrenal tumor is performed using minimally invasive surgery (laparoscopic surgery). Your surgeon will make a few small cuts (incisions) in your stomach (abdomen) to insert wandlike devices equipped with video cameras and small tools to perform the surgery.
In most cases, your surgeon removes the entire adrenal gland with a pheochromocytoma. However, your surgeon might remove only the tumor, leaving some healthy adrenal gland tissue. This may be done when the other adrenal gland has also been removed or when there are tumors in both adrenal glands.
If a tumor is cancerous, the tumor and other cancerous tissue will be removed. Even if all the cancerous tissue isn't removed, surgery and medical therapy might reduce hormone production and provide some blood pressure control.
The remaining healthy adrenal gland can carry out the functions normally performed by two glands. Blood pressure usually returns to normal. You'll need regular medical appointments with your health care provider for life to monitor your health, identify complications or see if the tumor has returned.
Very few pheochromocytomas are cancerous. As such, research about the best treatments is limited. Treatments for cancerous tumors and cancer that has spread in the body, related to a pheochromocytoma, may include:
- Targeted therapies using a drug or compound that seeks out cancer cells, combined with a radioactive substance that kills them. Drug treatments that focus on specific abnormalities within cancer cells that allow them to survive may also be an option.
- Chemotherapy using powerful drugs that kill fast-growing cancer cells.
- Radiation therapy that may relieve symptoms of tumors that have spread to the bone and are causing pain.
Preparing for your appointment
You're likely to start by seeing your primary health care provider. Then you might be referred to a specialist in hormonal disorders (endocrinologist).
Here's some information to help you get ready for your appointment. You may want to take a family member or friend along, if possible, to help you remember the information.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting or making medication changes before having a specific test.
Before your appointment make a list of:
- Your symptoms, including any changes from how you typically feel, when they began and how long they last
- Key personal information, including major stresses, recent life changes and family medical history
- All medications, vitamins, herbs and other supplements you take, including doses
- Questions to ask your health care provider
Questions to ask may include:
- What's likely causing my symptoms?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely temporary or ongoing?
- What treatment do you recommend?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your health care provider is likely to ask you questions, including:
- Have your symptoms been continuous, or do they come and go?
- Does anything seem to improve your symptoms?
- What, if anything, appears to trigger or worsen your symptoms?
- Have you been diagnosed with other medical conditions? If so, what treatment are you getting?
- Do you have a family history of adrenal or other endocrine tumors?