Paroxysmal hypertension (pseudopheochromocytoma)
- Samuel J Mann, MD
Samuel J Mann, MD
- Professor of Clinical Medicine
- New York Presbyterian Hospital Weill Cornell Medical Center
The presence of severe and symptomatic paroxysmal hypertension should always generate suspicion of a catecholamine-secreting pheochromocytoma . However, the reality is that this tumor is rarely found among such patients . In one report, the diagnosis was established in only 1 of 300 patients evaluated for pheochromocytoma . Up to 40 percent of patients in this series fulfilled the criteria for panic disorder.
In most patients with paroxysmal hypertension and a negative evaluation for pheochromocytoma, the cause remains unknown, treatment is difficult, and many incur chronic disability. This clinical constellation is sometimes called "pseudopheochromocytoma" . A paucity of data concerning the clinical characteristics of this disorder exists.
The proposed cause, clinical features (including link to emotions), differential diagnosis, and management of pseudopheochromocytoma will be reviewed here. The diagnosis and treatment of pheochromocytoma and panic disorder are presented separately. (See "Clinical presentation and diagnosis of pheochromocytoma" and "Treatment of pheochromocytoma in adults" and "Pharmacotherapy for panic disorder".)
Pseudopheochromocytoma most likely involves activation of the sympathetic system; this has been inferred from the following observations [5-11]:
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- CLINICAL MANIFESTATIONS
- Psychological characteristics
- DIFFERENTIAL DIAGNOSIS
- Labile hypertension
- Panic disorder
- Other causes of paroxysmal hypertension
- Antihypertensive agents
- - Acute management of paroxysms
- - Chronic preventive management
- Psychopharmacologic agents
- Psychotherapeutic intervention
- Obstacles to successful treatment
- SUMMARY AND RECOMMENDATIONS