Pheochromocytoma and Paraganglioma

The NP's first task is not to diagnose pheochromocytoma from one symptom or one blood-pressure reading. It is to recognize when ordinary hypertension no longer explains the pattern. Abrupt spells of headache, palpitations, diaphoresis, pallor, and marked blood-pressure elevation may reflect catecholamine release; another patient may have sustained hypertension or a crisis during anaesthesia, surgery, micturition, abdominal-pressure changes, or exposure to a provoking medication. Confirm suspected disease biochemically before ordering localization imaging. A correctly collected test, medication review, and timely referral are safer than chasing an incidental adrenal finding or treating the presentation as uncomplicated essential hypertension. In Canada, a strongly suspected or biochemically positive case should be coordinated with endocrinology or a specialized hypertension centre. The critical prescribing sequence is alpha blockade first; beta blockade comes later, if needed for tachycardia or arrhythmia.