The adrenal glands produce the hormone norepinephrine, a potent form of the “fight or flight” hormone epinephrine. Tumors of the adrenal glands called pheochromocytomas produce abnormally high levels of norepinephrine. The majority of pheochromocytomas are noncancerous. These tumors can occur sporadically or with the hereditary disorders multiple endocrine neoplasia types 2A and 2B, von Hippel-Lindau disease and neurofibromatosis type 1. Occasionally, elevated norepinephrine levels occur with adrenal medullary hyperplasia, an overgrowth of the tissues that produce the hormone.
High Blood Pressure
Markedly elevated blood pressure levels characterize pheochromocytomas, occurring in at least 90 percent of people with this type of tumor. Approximately half of those affected exhibit persistently high blood pressure. Others experience periodic blood pressure spikes with normal blood pressure between attacks.
Severe, throbbing headaches occur in most people with elevated norepinephrine levels. The headaches typically correlate to the marked elevation in blood pressure caused by norepinephrine.
Profuse sweating, especially in the trunk of the body, is a common occurrence with pheochromocytoma. Excessive sweating is a complaint in 60 to 70 percent of people with this disorder. Heat intolerance typically accompanies this symptom.
A heart palpitation refers to a conscious awareness of the heartbeat, usually due to an abnormal rhythm, rate or force. Heart palpitations commonly occur among people with elevated norepinephrine levels. Increased heart rate and forcefulness typify the disorder. Chest pain may accompany heart palpitations. Approximately 90 percent of people presenting with heart palpitations, profuse sweating, headaches and high blood pressure have a pheochromocytoma.
Anxiety and Nervousness
Profound anxiety may accompany the elevated norepinephrine levels seen among people with pheochromocytoma. In some people, the anxiety may progresses to the threshold of panic. Anxiety and nervousness occur in approximately 20 percent and 40 percent of people with a pheochromocytoma, respectively.
Nausea, Vomiting and Constiption
Many people with elevated norepinephrine levels experience nausea and vomiting. Constipation may also occur, which may be accompanied by abdominal pain. Unintentional weight loss occurs in some people with a pheochromocytoma.
Norepinephrine causes narrowing of the blood vessel near the skin and in the extremities. This effect often leads to pallor, or paleness of the skin. The skin also commonly feels cool to the touch. Pallor occurs in up to 60 percent of people with a symptomatic pheochromocytoma.
See your doctor if you have symptoms that may indicate a pheochromocytoma, especially if you experience several of these symptoms. Surgery is typically the treatment of choice. Medications are also used to treat symptoms.
- The Merck Manual Professional Edition: Pheochromocytoma
- University of Virginia Health System: Pheochromocytoma
- Endocrine Tumors; Orlo H. Clark
- Conn's Current Therapy 2015; Edward T. Bope and Rick D. Kellerman