Exercise-induced nausea and vomiting: another sign and symptom of pheochromocytoma and paraganglioma

Endocrine. 2010 Jun;37(3):403-7. doi: 10.1007/s12020-010-9319-3. Epub 2010 Apr 21.


A cohort of nine patients, mostly young adults, presented with a new sign/symptom of pheochromocytoma/paraganglioma: exercise-induced nausea and vomiting. The aims of this article are to introduce this sign/symptom and offer a possible hypothesis for the observation. Following a 2000 report from a paraganglioma patient experiencing exercise-induced nausea and vomiting, we began asking patients about instances of nausea and vomiting with exercise. A total of nine patients, 4.4% of our pheochromocytoma/paraganglioma population, presented with reports of exercise-induced nausea and vomiting, initially with moderate-to-intense levels of exercise, at the first presentation of their disease. All of these patients reported a cessation of exercise-induced nausea and vomiting following the removal of their primary tumor. Two patients with metastatic disease to the lungs reported a recurrence of exercise-induced nausea and vomiting. The majority of patients studied were young adults with mean onset age of 19.4 years (range of 9-51 years) and the mean age of diagnosis being 24.1 years (range of 11-53 years). Exercise-induced nausea and vomiting should be considered a sign/symptom of pheochromocytoma/paraganglioma and should be addressed in the clinical evaluation of these patients, especially in young adults. Whether exercise-induced elevated catecholamine levels could account for the induced nausea and vomiting via activation of adrenergic receptors in the area postrema remains to be established.

Publication types

  • Case Reports
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / pathology
  • Adult
  • Child
  • Dopamine / blood
  • Exercise*
  • Female
  • Humans
  • Male
  • Metanephrine / blood
  • Middle Aged
  • Nausea / etiology*
  • Norepinephrine / blood
  • Paraganglioma / diagnosis*
  • Paraganglioma / secondary
  • Pheochromocytoma / diagnosis*
  • Pheochromocytoma / secondary
  • Vomiting / etiology*
  • Young Adult


  • Metanephrine
  • Dopamine
  • Norepinephrine