Epinephrine-containing dental anesthetics — inform your dentist of your diagnosis
Foods to avoid
Aged cheeses, cured or smoked meats, fermented foods, red wine
These foods can trigger a blood pressure surge
Diet and fluid instructions
High-salt diet if on preoperative alpha-blockade
Your doctor may recommend extra salt to keep blood pressure stable on your medications
Drink plenty of fluids — aim for approximately 2.5 litres daily
This helps prevent dehydration and light-headedness
Activity restrictions
Avoid heavy lifting, straining, or vigorous exertion until cleared by your surgeon
Physical strain can trigger a release of adrenaline from the tumor
Avoid Valsalva maneuvers (bearing down)
Increased abdominal pressure can squeeze the tumor
Genetic testing and family notification
Genetic testing is recommended for all patients with pheochromocytoma
Up to 40% of patients have a hereditary genetic mutation
Your blood relatives may need screening if you have a genetic mutation identified
Carry medical identification
Wear or carry a medical alert stating you have a pheochromocytoma
Alert any healthcare provider before receiving new medications or undergoing procedures
Follow-up appointments
Endocrinology follow-up within 2 weeks of discharge
Adjustment of alpha-blockade medications
Blood pressure monitoring and labs
Surgical consultation for adrenalectomy planning
Surgery is the only cure for pheochromocytoma
Your surgeon will determine the safest timing based on your recovery
Cardiology follow-up if heart function was affected
Repeat echocardiogram to confirm heart recovery
Return to emergency department immediately if
Severe headache, especially with sweating and racing heart
Classic signs of another crisis
Blood pressure reading at home above 180/120 mmHg
Chest pain or shortness of breath
Heart racing or irregular heartbeat
Confusion, vision changes, or weakness
Fainting or near-fainting
High fever with confusion or altered mental state
Signs of pheochromocytoma multisystem crisis
References
Guidelines and key sources
Ando Y, et al. Clinical Characteristics and Outcomes of Pheochromocytoma Crisis: A Literature Review of 200 Cases. Journal of Endocrinological Investigation. 2022. PMID 35857218
200-case literature review; headache 39.5%; nausea/vomiting associated with higher mortality
Heart most commonly damaged organ (99%), lungs (44%), kidneys (21.5%)
Sauneuf B, et al. Pheochromocytoma Crisis in the ICU: A French Multicenter Cohort Study. Critical Care Medicine. 2017. PMID 28403121
Median LVEF 30% in ICU cohort
VA-ECMO survival ~93.5% with full LV recovery in survivors
Whitelaw BC, et al. Phaeochromocytoma crisis. Clinical Endocrinology. 2014.
Type A and Type B crisis classification
PMC defined: hyperthermia + encephalopathy + labile BP + multi-organ failure (19% of cases)
Nazari MA, et al. Catecholamine-Induced Hypertensive Crises: Current Insights and Management. Lancet Diabetes Endocrinology. 2023. PMID 37944546
Comprehensive review of pathophysiology and management strategies
BP target: reduce SBP 25% in first hour; <140 mmHg over 24-48 hours
Jones DW, et al. 2025 AHA/ACC/AANP Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JACC. 2025.
Phentolamine and clevidipine recommended for catecholamine excess states
First-line IV alpha-blockade before beta-blockade
Nazari MA, Rosenblum JS, Haigney MC, Pacak K. Pathophysiology and Acute Management of Tachyarrhythmias in Pheochromocytoma. JACC. 2020. PMID 32703516
Comprehensive arrhythmia management; esmolol preferred for rate control after alpha-blockade
Epinephrine phenotype: Takotsubo and tachyarrhythmia risk; norepinephrine phenotype: atherosclerosis and flash pulmonary edema
Neumann HPH, Young WF, Eng C. Pheochromocytoma and Paraganglioma. NEJM. 2019. PMID: 31875526
Landmark review of genetics, diagnosis, and management
Up to 40% germline pathogenic variants; genetic testing recommended for all
NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. Updated 2026.
Genetic testing recommended for ALL PPGL patients
Comprehensive surveillance and management algorithms
Giraud R, et al. Pheochromocytoma Multisystem Crisis Requiring Temporary Mechanical Circulatory Support: A Narrative Review. JCM. 2025. PMID 40142715
PMC management; early mechanical circulatory support recommendation
Ferreira VM, et al. Pheochromocytoma Is Characterized By Catecholamine-Mediated Myocarditis, Focal and Diffuse Myocardial Fibrosis. JACC. 2016. PMID 27199060
MRI-confirmed myocardial fibrosis and catecholamine cardiomyopathy mechanism
Y-Hassan S, Falhammar H. Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas. JCM. 2020. PMID 32751501
PPGL-related TTS cardiogenic shock rate 34% vs 4% in non-PPGL TTS
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.