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Unexplained Symptomatic Paroxysmal Hypertension: a Diagnostic and Management Challenge

  • Kelly DyerEmail author
  • Theresa E. Vettese
Clinical Practice: Clinical Vignettes

INTRODUCTION

Symptomatic paroxysmal hypertension is considered the hallmark symptom of pheochromocytomas. Pheochromocytomas, however, are exceedingly rare and are diagnosed in 2% of patients with hypertensive paroxysms.1 As a result, clinicians and patients are often left frustrated and confused when a diagnostic evaluation of symptomatic paroxysmal hypertension is un-revealing for a pheochromocytoma. Frequently, these patients undergo multiple and often unnecessary testing, as was the case with our patient. The differential diagnosis is broader than most clinicians realize and includes conditions such as prescription and illicit drug use, obstructive sleep apnea, panic attacks, and pseudopheochromocytoma. Of these, pseudopheochromocytoma is perhaps the least understood and considered.

CASE

A 58-year-old woman with a past medical history of well controlled HIV and a diagnosis of seizure disorder presented with severe hypertension and headache. According to the patient’s husband, she...

Notes

Contributors

There were no further contributors to the paper. Contributors all met criteria for authorship.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001;134 (4):315-329.CrossRefGoogle Scholar
  2. 2.
    Kuchel O, Buu NT, Hamet P, Larochelle P, Bourque M, Genest J. Essential hypertension with low conjugated catecholamines imitates pheochromocytoma. Hypertension. 1981;3(3) :347-355.CrossRefGoogle Scholar
  3. 3.
    Sharabi Y, Goldstein DS, Bentho O, Saleem A, Pechnik S, Geraci MF, Holmes C, Pacak K, Eisenhofer G. Sympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma. J Hypertens. 2007;25(11):2286-2295.CrossRefGoogle Scholar
  4. 4.
    Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma): Understanding the cause and treatment. Arch Intern Med. 1999;159 (7):670-674.CrossRefGoogle Scholar
  5. 5.
    Mann SJ. Severe paroxysmal hypertension: An automatic syndrome and its relationship to repressed emotions. Psychosomatics. 1996;37(5):444-450.CrossRefGoogle Scholar
  6. 6.
    Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma). Curr Hypertens Rep. 2008;10 (1):12-18.CrossRefGoogle Scholar
  7. 7.
    Mackenzie IS, Brown JB. Pseudopheochromoctyoma. J Hypertens. 2007;(24):2204-2206.CrossRefGoogle Scholar
  8. 8.
    Hamada M, Shigematsu Y, Mukai M, Kazatani Y, Kokubu T, Hiwada K. Blood pressure response to the Valsalva maneuver in pheochromocytoma and pseudopheochromocytoma. Hypertension. 1995;25(2):266-271.CrossRefGoogle Scholar
  9. 9.
    Kuchel O, Buu NT, Hamet P, Larochelle P, Bourque M, Genest J. Dopamine surges in hyperadrenergic essential hypertension. Hypertension. 1982;4(6):845-852.CrossRefGoogle Scholar
  10. 10.
    Pickering T, Clemow L. Paroxysmal hypertension: The role of stress and psychological factors. J Clin Hypertens. 2008; 10 (7): 575-581.CrossRefGoogle Scholar
  11. 11.
    Eisenhofer G, Sharabi Y, Pacak K. Unexplained symptomatic paroxysmal hypertension in pseudopheochromocytoma: A stress response disorder? Ann N Y Acad Sci. 2008; 1148: 469-478.CrossRefGoogle Scholar
  12. 12.
    Dobri G., Bravo E., Hamrachian A. Pheochromocytoma: Pitfalls in the biochemical evaluation. Expert Rev Endocrinol Metab. 2014; 9 (2): 123-135.CrossRefGoogle Scholar
  13. 13.
    Martucci VL, Pacak K. Pheochromocytoma and Paraganglioma: diagnosis, genetics, management and treatment, Curr Probl Cancer. 2014; 38(1): 7-41.CrossRefGoogle Scholar
  14. 14.
    Mann SJ. Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies. Curr Cardiol Rep. 2015;17(11):99.CrossRefGoogle Scholar
  15. 15.
    Mann SJ. Redefining beta-blocker use in hypertension: selecting the right beta-blocker and the right patient. J Am Soc Hypertens. 2017;11(1):54-65.CrossRefGoogle Scholar
  16. 16.
    Mann SJ. Neurogenic hypertension: Pathophysiology, diagnosis and management. Clin Auton Res. 2018; 28: 363-374.CrossRefGoogle Scholar
  17. 17.
    Vaclavik J, Krenkova E, Vaclavik T, Kamasova M. Effect of sertraline in paroxysmal hypertension. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018; 162 (2): 116-120.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Division of General Medicine and Geriatrics, Department of MedicineEmory University School of MedicineAtlantaUSA

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