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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