Pheochromocytoma (Pheo) is a rare cause of hypertension (HTN). Classically, a 
triad of symptoms includes sweating, palpitations, and headache. HTN is often 
present and labile. Although a triad of symptoms is cited as the most frequent 
presenting complaints, our clinical experience leads us to question how often 
these are present. Thirty-two patients with histologically proven pheo or 
paraganglionoma were evaluated. Around 84.4% patients had adrenal pheos and 
15.6% had extra-adrenal pheos. Two patients had bilateral adrenal tumors, two 
had a history of prior pheos, and four had a family history of pheo. There were 
19 (59.4%) female and 13 (40.6%) male patients. Six (18.7%) patients were black 
and 26 (81.3%) were white. The mean age at presentation was 43.2+/-13.9 years. 
Two patients were known to have neurofibromatosis type 1, two had von 
Hippel-Lindau disease, one had multiple endocrine neoplasia 2A, and one PGL/SDHD 
genetic mutation. Twenty-six patients had sporadic tumors or had not had genetic 
testing. Biochemical diagnosis was confirmed with 24-h urine measurements. Urine 
catecholamine measurements were elevated at least 2 to 4 times above normal 
levels. Mean SBP readings at presentation were 128+/-19 mmHg. Mean DBP readings 
were 81+/-13 mmHg. Around 65.6% patients were hypertensive at presentation. 
Fifty percent of the patients had palpitations, 40.6% had tachycardia, 34.4% had 
sweating, and 31.3% had headaches. Initial presenting symptoms were diverse. 
Pheo is a rare clinical entity and remains a huge diagnostic challenge for all 
clinicians.