Unexplained Symptomatic Paroxysmal Hypertension: a Diagnostic and Management Challenge

Excerpt

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. …