27th May 2025

Complications

Acute hypertensive crisis is the most common complication of phaeochromocytoma. It presents with severe hypertension, shock and circulatory failure. End organ damage can occur including myocardial infarction, cerebral haemorrhage and heart failure. Precipitating factors include anaesthesia, opiates, cocaine, tricyclic antidepressants, contrast media, dopamine antagonists, pregnancy and childbirth. The first-line treatment is phentolamine 5-20mg IV, or nitroprusside 0.3 to 0.5 mcg/kg/min IV infusion.

Other complications include hypertensive encephalopathy due to long-term severe hypertension, presenting with altered cognition and mental status, focal neurology and seizures. The risk of cerebral haemorrhage and cerebrovascular accidents is also increased in hypertensive crises.