Severe Paroxysmal Hypertension (Pseudopheochromocytoma)

Abstract

Paroxysmal hypertension always engenders a search for a catecholamine-secreting pheochromocytoma, Yet <2% turn out to have this tumor, and its cause and management have remained a mystery, and the subject of remarkably few papers. This review presents an approach to understanding and treating this disorder, which is increasingly known as “pseudopheochromocytoma.” Patients experience symptomatic blood pressure surges likely linked to stimulation of the sympathetic nervous system. Psychological characteristics of patients with this disorder suggest a psychological basis, attributable to repressed emotion related either to prior emotional trauma or to a repressive (non-emotional) coping style. Interventions based on this understanding appear helpful in most cases. Paroxysms can be treated with an anxiolytic (e.g. alprazolam) and/or oral clonidine; an anxiolytic plus intravenous labetalol are usually effective in severe paroxysms. For preventive therapy, antidepressant agents appear effective in most patients. Although the role of psychotherapy is unclear, reassurance that an acute cardiovascular event is unlikely to occur during a paroxysm can be helpful. Fortunately, with appropriately selected intervention, attacks can be reduced or eliminated in most patients.