PHEOCHROMOCYTOMA AS A CAUSE OF SECONDARY HYPERTENSION IN ADULTS: SCOPING SYSTEMATIC REVIEW OF RECENT EVIDENCE (2024–2025)

Abstract

This article is an exploratory systematic review of recent evidence (2024-2025) on pheochromocytoma/paraganglioma (PPGL) as a cause of secondary hypertension in adults. It highlights that, although infrequent, PPGL is a relevant cause of HTA. A paradigm shift is observed in its detection, moving from symptomatic presentation to an incidental finding in imaging studies. Hypertension remains the predominant clinical manifestation (present in 80-90% of cases), while the classic triad of headache, palpitations, and diaphoresis is increasingly less frequent. A subgroup of patients is even normotensive, with their diagnosis being a radiological finding. Standard diagnostic methods, such as the measurement of plasma or urinary metanephrines and imaging techniques (CT/MRI), remain in force. However, gaps are identified in clinical practice, with suboptimal screening rates for incidentalomas. Promising innovations are explored, such as radiomics to predict intraoperative hypertensive crises and microRNA profiles combined with machine learning to discriminate subtypes of hypertension. The study also underscores the importance of genetic evaluation, given that almost a third of cases have a hereditary component, and the need for longitudinal follow-up due to recurrence and metastasis rates. It is concluded that increased clinical suspicion, standardized screening protocols, and multicenter registries are key to improving diagnosis and patient safety.