Can pheochromocytoma metastasize?

Written by Hao Li Bin
Neurosurgery
Updated on April 25, 2025
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Pheochromocytoma is a special type of tumor originating from chromaffin cells of the adrenal gland. Most of these tumors are benign, with only a minority of patients experiencing malignancy. Clinically, the likelihood of tumor malignancy is about 10%. Most patients have a good prognosis after surgical removal, and if the tumor shows distant metastasis, it can be determined that the disease has become malignant. Due to the unique origin of pheochromocytomas in the adrenal medulla chromaffin cells, the tumor tissue continuously grows in the body and synthesizes and metabolizes catecholamines such as adrenaline, dopamine, and noradrenaline. Clinically, nearly 90% of patients do not develop cancer throughout their lives, therefore most pheochromocytomas are benign. However, about 10% of patients experience distant metastases, and once metastasized, it is considered a malignant tumor.

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How is pheochromocytoma diagnosed?

For the examination of pheochromocytoma, it is generally recommended to use qualitative or localization diagnostic methods. Qualitative examinations typically involve collecting metabolites of catecholamines from urine and blood to further facilitate a definitive diagnosis. Localization examinations are conducted through abdominal ultrasound, CT, or MRI to further identify the specific growth location of the pheochromocytoma. After a definitive diagnosis through qualitative and localization examinations, surgery is generally recommended to effectively remove the pheochromocytoma. Additionally, antihypertensive medication can be used to help control symptoms.

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Malignant manifestations of pheochromocytoma

For patients with pheochromocytoma, when malignant pheochromocytoma occurs and leads to hypertensive crisis, it often causes severe blood pressure increases, with blood pressure even reaching over 300 mmHg. At the same time, patients present with significant symptoms such as arrhythmia, tachycardia, palpitations, and shortness of breath. Some patients may also experience prominent chest pain, labored breathing, respiratory distress, and even marked sensations of urgency or anxiety, as well as a feeling of impending doom. Additionally, some patients may experience transient vascular constriction dysfunction due to severe hypertension, leading to cerebral hemorrhage.

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Causes of hypotension in pheochromocytoma

For cases of hypotension occurring in pheochromocytoma, it is most commonly seen after the surgical removal of the tumor. At this point, the concentration of catecholamines in the blood may significantly decrease, leading to a marked reduction in effective circulating blood volume, and thus causing hypotension. This situation is relatively common after surgery for pheochromocytoma. Usually, after surgical treatment and removal of the tumor, it is important to promptly discontinue the use of receptor blockers in patients and to appropriately replenish blood volume to effectively maintain central venous pressure. This approach can generally counteract the reduction in catecholamine levels caused by surgery, which leads to hypotension.

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What department should I go to for pheochromocytoma?

Pheochromocytoma generally requires consultation at the endocrinology or surgical department. Please ask a physician to assess the current situation. For further examination and diagnosis of pheochromocytoma, qualitative and locational diagnostics are necessary. Qualitative diagnostics typically involve blood tests where levels of catecholamine metabolites in the blood and urine are tested to assist in diagnosis; locational diagnostics involve using CT scans, MRI, and ultrasound to help determine the specific location of the tumor. Treatment for pheochromocytoma generally involves surgical removal of the tumor once it is found, combined with medication treatment, which often leads to satisfactory therapeutic outcomes.

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Pheochromocytoma clinical manifestations

Pheochromocytoma typically presents with severe hypertension, with blood pressure even reaching above 200/140 mmHg, accompanied by significant discomfort, such as profuse sweating, chest pain, obvious difficulty in breathing, chest tightness, shortness of breath, and other clinical manifestations. Moreover, if not treated timely and effectively, it can even lead to a hypertensive crisis. It also poses a severe threat to the patient’s heart, kidneys, liver, and brain tissues. Some patients might develop cerebrovascular diseases due to very high blood pressure, such as hypertensive cerebral hemorrhage, which can threaten the patient's life.