Merck Manual

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Professional Version



Robert J. Kemppainen

, DVM, PhD, Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University

Reviewed/Revised Apr 2019 | Modified Oct 2022

Pheochromocytomas are rare tumors that originate from the adrenal medulla. They have been most commonly reported in dogs, horses, and cattle. Clinical signs associated with pheochromocytomas are nonspecific, and these tumors can be challenging to diagnose.

Pheochromocytomas occur in domestic species, including dogs and rarely cats. They also occur in horses and cattle. Incidental masses in the area of the adrenal glands are being discovered with greater frequency because of the increased use of abdominal ultrasound and other imaging techniques. Pheochromocytoma, although rare, should be a differential diagnosis whenever such a mass is identified.

Pheochromocytomas arise from the adrenal medullary chromaffin cells that normally synthesize and secrete the catecholamines epinephrine and norepinephrine. These tumors have been identified more often in dogs than in cats, usually affect only one gland, and tend to occur in older animals. They are often locally invasive (may result in thrombus formation in the adjacent vena cava) and metastasize in≥25% of cases. Extra-adrenal sites for related tumors (paragangliomas) have been reported in other tissues, including the heart.

Diagnosis of pheochromocytoma is challenging. Clinical signs are nonspecific and may appear sporadically, possibly related to periodic or intermittent release of catecholamines. In addition, signs may vary depending on which catecholamine predominates.

Signs reported in most dogs include:

  • weight loss

  • anorexia

  • depression

  • weakness

  • occasional collapse

Dyspnea and tachycardia may be seen, and hypertension is common; indirect blood pressure measurement can help establish the diagnosis. Imaging, such as ultrasonography or CT scans, is very useful in confirmation of a suspected adrenal mass. The much more common adrenal disorder hyperadrenocorticism is a differential when an adrenal mass is identified.

Although surgical removal is the treatment of choice, animals with pheochromocytoma present an anesthetic risk secondary to the cardiovascular effects of the catecholamines. Surgery is additionally complicated by the tendency toward local invasion of these tumors and their proximity to large vessels.

Adrenal Medullary Hyperplasia

Diffuse or nodular adrenal medullary hyperplasia appears to precede the development of pheochromocytomas in bulls with C-cell tumors of the thyroid gland. This diffuse proliferation of chromaffin cells is nonencapsulated but compresses the surrounding adrenal cortex. In bulls with prominent diffuse medullary hyperplasia, there are often a few small foci of intense nodular proliferation of medullary cells.

Key Points

  • Pheochromocytomas are rare tumors that affect the adrenal gland.

  • Pheochromocytomas have been reported in multiple species, most commonly in dogs.

  • Clinical signs in affected animals are nonspecific, and the diagnosis can be challenging.

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