Nursing care
Pheochromocytoma nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated September 2026
Short answer
Pheochromocytoma nursing care centres on recognising episodic severe hypertension with headache, sweating and palpitations, and avoiding abdominal palpation, which can trigger a catecholamine crisis. Priority actions are blood pressure monitoring, a calm low-stimulation environment, and alpha-blockade before any beta-blocker or surgery.
Recognising it at the bedside
The picture is episodic, not constant. A patient has a severe hypertensive spike with a pounding headache, drenching sweat and palpitations, then settles back toward baseline within an hour. Between episodes, blood pressure can look unremarkable, which is exactly why the history matters more than a single reading.
Ask what preceded the episode. Straining at stool, a full bladder, emotional stress, anaesthesia induction, or abdominal palpation on examination can all provoke a surge as the tumour releases catecholamines. If a patient describes this pattern spontaneously, take it seriously even if their chart shows normal vitals right now.
Why the classic presentation misleads
The triad of headache, sweating and palpitations overlaps with anxiety, panic disorder and menopause, and patients are frequently reassured or treated for those instead. A nurse who only checks blood pressure at a scheduled interval can easily miss the crisis window entirely, since readings between episodes may sit near normal.
The abdominal exam is the trap specific to this condition. Routine abdominal palpation, intended to assess for a mass, can mechanically compress the adrenal tumour and precipitate the very crisis being investigated. Once pheochromocytoma is suspected, deep or repeated abdominal palpation should be avoided, and this needs to be communicated to anyone examining the patient, not just documented in a note.
Priority nursing actions
During a suspected crisis, get a manual blood pressure and heart rate immediately, position the patient semi-Fowler's, and keep the environment quiet and dim, since stimulation itself can worsen the surge. Have IV access established and notify the provider without delay; a phentolamine or nicardipine infusion is the usual response to a hypertensive emergency of this cause.
Never give a beta-blocker before alpha-blockade is established. Unopposed alpha stimulation from beta-blockade alone can cause a paradoxical and severe rise in blood pressure. Preoperatively, expect the patient to be on phenoxybenzamine or another alpha-blocker for one to two weeks before surgery, with a beta-blocker added only afterward if needed for tachycardia.
Labs and diagnostics to expect
Plasma free metanephrines or a 24-hour urine collection for fractionated metanephrines and catecholamines confirms the diagnosis biochemically. For the urine collection, coach the patient to avoid caffeine, nicotine, and strenuous exercise beforehand, since all three can falsely elevate results.
Once biochemical confirmation is in hand, CT or MRI of the adrenal glands localises the tumour. Blood glucose is also worth watching: catecholamine excess can cause hyperglycaemia, and this can shift once the tumour is removed.
Complications and their early signs
Left untreated or unrecognised, a catecholamine surge can precipitate a hypertensive crisis with stroke, myocardial infarction, or catecholamine-induced cardiomyopathy. Watch for chest pain, visual changes, or acute confusion during an episode, as these signal end-organ involvement rather than a routine anxiety spike.
The postoperative period carries its own risk in the opposite direction: once the tumour is removed, the sudden drop in circulating catecholamines can cause profound hypotension. Continuous blood pressure monitoring and readiness to give IV fluids or vasopressors is standard in the immediate post-adrenalectomy window.
Teaching that changes outcomes
Teach patients to avoid known triggers: straining, an overly full bladder, and situations likely to cause emotional stress. They should also alert every new provider, including a dentist, that they have or are being evaluated for pheochromocytoma, because certain anaesthetics and contrast agents can provoke a crisis.
Reinforce medication adherence before surgery. Missing alpha-blocker doses in the preoperative window raises the risk of an intraoperative hypertensive crisis, and patients need to understand that this preparation phase is not optional padding but the thing that makes the surgery safe.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our endocrine practice questions are the closest set to what this page covers.
Common questions
Why can't you palpate the abdomen in suspected pheochromocytoma?
Palpation can mechanically compress the adrenal tumour and trigger a sudden catecholamine release, provoking a hypertensive crisis. Once the condition is suspected, abdominal exams should be gentle and this should be flagged to the whole care team.
What is the first-line medication before pheochromocytoma surgery?
An alpha-blocker, typically phenoxybenzamine, started one to two weeks before surgery to control blood pressure and expand blood volume. A beta-blocker is only added afterward if tachycardia persists, never given first.
What triggers a pheochromocytoma crisis?
Physical or emotional stress, straining, a full bladder, abdominal palpation, certain anaesthetics, and some foods or medications containing tyramine can all provoke a catecholamine surge.
How is pheochromocytoma diagnosed?
Plasma free metanephrines or a 24-hour urine test for fractionated metanephrines confirms elevated catecholamine metabolites, followed by CT or MRI to localise the tumour.
What should a nurse watch for after adrenalectomy?
Sudden hypotension as catecholamine levels drop postoperatively. Continuous blood pressure monitoring and prompt fluid or vasopressor support are expected in the immediate postoperative period.