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Pheochromocytoma: recent advances and speed bumps in the road to further progress.

Although the crucial initial step for diagnosis is to first think of the tumor, numerous advances in biochemical testing and imaging have considerably eased subsequent diagnostic steps. Other advances have widened the horizon of clinical situations where pheochromocytomas should be considered well beyond the usual patients with hypertension and symptoms of catecholamine excess. Recognition that pheochromocytomas should be routinely considered in patients with adrenal incidentalomas, irrespective of the presence of hypertension and symptoms, represents one such situation resulting from increased use of anatomic imaging. Advances in genetics have further indicated the importance of routinely screening for the tumor in patients with identified disease-causing mutations and, more recently, of considering an underlying mutation once pheochromocytoma is diagnosed.