Pheochromocytoma Rule of 10 Mnemonic [Easy to remember]

Let’s talk about a tumour that’s discussed in exams 10 times more than it’s ever seen in real life: Pheochromocytoma.

(Seriously — I’ve had more lectures on it than actual patients. But when it does show up, it makes an entrance — with pounding headaches, skyrocketing BP, and enough sweating to power a sauna. 😅)

The key to remembering its features? The Rule of 10s. 🧮

Mnemonic Table: Pheochromocytoma — Rule of 10s

10%…	Meaning
10% Malignant	Roughly 10% are cancerous and capable of metastasis. 🧬💣
10% Bilateral	10% involve both adrenal glands (so don’t get lazy with imaging). 🫁🫁
10% Extra-adrenal	10% occur outside the adrenal glands — aka paragangliomas. 🧠🧠
10% Calcified	10% show calcifications on imaging. If it glows and crunches, think twice. 🦴🧲
10% Pediatric	10% occur in children. Think neuroendocrine mischief early. 🧒📈
10% Familial	10% have genetic links (MEN2, VHL, NF1). Always ask about family history! 🧬👨‍👩‍👦

🩺 Field Notes from Quetta

At Sheikh Khalifa Bin Zayed Hospital, I’ve only encountered one confirmed pheochromocytoma — but it was unforgettable. A middle-aged woman with refractory hypertension, sweating buckets, and panic attacks that mimicked anxiety disorder.

Her 24-hour urinary metanephrines were sky-high, and imaging lit up a unilateral adrenal mass. Classic. (And yes, the intern almost passed out during the adrenalectomy pre-op spike. Good times. 😅)

🔍 Clinical Pearls

Always suspect pheo in young hypertensives, especially if BP spikes are episodic, or associated with palpitations, pallor, and panic.
Rule of 10s isn’t gospel — but it’s a solid starting point. Some sources now cite up to 25% familial in newer studies.
Post-op hypotension is real. These patients can crash when the catecholamine factory is removed — keep your fluids and vasopressors ready.

📌 Bonus Tip

Think of pheochromocytoma like that dramatic friend: Mostly benign, occasionally toxic, always overreacting.

But you’ll miss it if you don’t listen carefully. 😀

HAPPY LEARNING, folks! 🙂

Signing off,

Dr. Aurangzaib Qambrani
(MBBS, PLAB, MRCP-UK)
Sheikh Khalifa Bin Zayed Hospital, Quetta
General Medicine | Gastroenterology | Cardiac Care Unit

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