Phaeochromocytoma

1. Big picture

Phaeochromocytoma is a catecholamine-secreting tumor of the adrenal medulla. Together with extra-adrenal paragangliomas, it belongs to the group called PPGLs: phaeochromocytoma/paraganglioma.

The classic exam picture is:

episodic hypertension + headache + sweating + palpitations + pallor/tremor

The most dangerous clinical point is treatment order:

Alpha blockade first → then beta blockade if needed → then surgery.

Never give a beta blocker first, because blocking β-mediated vasodilation while α-receptors remain stimulated can cause unopposed alpha vasoconstriction → hypertensive crisis.