open access

Vol 27, No 1 (2023)
Case report
Published online: 2023-01-31
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Pseudopheochromocytoma — an epidemic of the modern world? Case series and review of literature

Karolina Jażdżewska1, Konrad Grych1, Łukasz Obołończyk2, Krzysztof Sworczak2
·
Arterial Hypertension 2023;27(1):56-62.
Affiliations
  1. Scientific Student Group at Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
  2. Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland

open access

Vol 27, No 1 (2023)
CASE REPORT
Published online: 2023-01-31

Abstract

Background: Pseudopheochromocytoma is a condition that occurs more frequently than other diseases presenting with similar symptoms such as: paroxysmal hypertension, diaphoresis, pallor, palpitations. However, due to the lack of specific guidelines and awareness among physicians, it is widely underdiagnosed. Conventional antihypertensive treatment is ineffective in controlling symptoms which leads to decreased quality of life in patients affected by this disorder.

Case presentation: In our paper, we present three female patients with paroxysmal hypertension who were admitted to the Department of Endocrinology for an investigation of suspected pheochromocytoma. The biochemical findings and imaging carried out at the hospital ruled out the diagnosis of an adrenal tumor in all three of the patients. Given the proposed criteria the clinical features of the patients were suggestive of pseudopheochromocytoma. In all three cases, the anxiolytic or SSRI treatment was applied with satisfactory symptom control.   

Conclusions: After ruling out pheochromocytoma in patients presenting with paroxysmal hypertension, physicians should consider a diagnosis of pseudopheochromocytoma. Management of the disorder should include anxiolytic, antidepressant, α-adrenoceptor blockers, and β-adrenoceptor blockers treatment, with close cooperation between hypertension specialist and psychiatrist or psychologist. Early proper diagnosis can reduce emotional distress related to an extensive diagnostic process as well as the overall cost of healthcare in patients with pseudopheochromocytoma.

Abstract

Background: Pseudopheochromocytoma is a condition that occurs more frequently than other diseases presenting with similar symptoms such as: paroxysmal hypertension, diaphoresis, pallor, palpitations. However, due to the lack of specific guidelines and awareness among physicians, it is widely underdiagnosed. Conventional antihypertensive treatment is ineffective in controlling symptoms which leads to decreased quality of life in patients affected by this disorder.

Case presentation: In our paper, we present three female patients with paroxysmal hypertension who were admitted to the Department of Endocrinology for an investigation of suspected pheochromocytoma. The biochemical findings and imaging carried out at the hospital ruled out the diagnosis of an adrenal tumor in all three of the patients. Given the proposed criteria the clinical features of the patients were suggestive of pseudopheochromocytoma. In all three cases, the anxiolytic or SSRI treatment was applied with satisfactory symptom control.   

Conclusions: After ruling out pheochromocytoma in patients presenting with paroxysmal hypertension, physicians should consider a diagnosis of pseudopheochromocytoma. Management of the disorder should include anxiolytic, antidepressant, α-adrenoceptor blockers, and β-adrenoceptor blockers treatment, with close cooperation between hypertension specialist and psychiatrist or psychologist. Early proper diagnosis can reduce emotional distress related to an extensive diagnostic process as well as the overall cost of healthcare in patients with pseudopheochromocytoma.

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Keywords

pseudopheochromocytoma; paroxysmal hypertension; pheochromocytoma; hypertension; panic attacks

About this article
Title

Pseudopheochromocytoma — an epidemic of the modern world? Case series and review of literature

Journal

Arterial Hypertension

Issue

Vol 27, No 1 (2023)

Article type

Case report

Pages

56-62

Published online

2023-01-31

Page views

2405

Article views/downloads

952

DOI

10.5603/AH.a2023.0005

Bibliographic record

Arterial Hypertension 2023;27(1):56-62.

Keywords

pseudopheochromocytoma
paroxysmal hypertension
pheochromocytoma
hypertension
panic attacks

Authors

Karolina Jażdżewska
Konrad Grych
Łukasz Obołończyk
Krzysztof Sworczak

References (20)
  1. Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment. Arch Intern Med. 1999; 159(7): 670–674.
  2. Kuchel O, Haber E, Dzau VJ et al. Clinical Conference Pseudopheochromocytoma Principal Discussant HYPERTENSION CLINICAL CONFERENCE Case Presentation. http://ahajournals.org.
  3. Mackenzie IS, Brown MJ. Pseudopheochromocytoma. J Hypertens. 2007; 25(11): 2204–2206.
  4. Mann SJ. Severe paroxysmal hypertension. An automatic syndrome and its relationship to repressed emotions. Psychosomatics. 1996; 37(5): 444–450.
  5. Turin C, Cohen D. Pseudopheochromocytoma: an Uncommon Cause of Severe Hypertension. Curr Cardiol Rep. 2022; 24(1): 59–64.
  6. Mann S. Severe Paroxysmal Hypertension (pseudopheochromocytoma). Curr Hypertens Rep. 2008; 10(1): 525–540.
  7. Sharabi Y, Goldstein DS, Bentho O, et al. Sympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma. J Hypertens. 2007; 25(11): 2286–2295.
  8. Zhou B, Carrillo-Larco RM, Danaei G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021; 398(10304): 957–980.
  9. Pacak K, Linehan WM, Eisenhofer G, et al. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001; 134(4): 315–329.
  10. Holzheimer RG, Mannick JA. (eds). Surgical Treatment: Evidence-Based and Problem-Oriented. , Munich 2001.
  11. Kuchel O. New Insights Into Pseudopheochromocytoma and Emotionally Provoked Hypertension. In: Masoor GA. ed. Secondary Hypertension. Clinical Presentation, Diagnosis, and Treatment. Springer Science, New York 2004.
  12. Pickering TG, Clemow L. Paroxysmal hypertension: the role of stress and psychological factors. J Clin Hypertens (Greenwich). 2008; 10(7): 575–581.
  13. Davies SJ, Ghahramani P, Jackson PR. Panic disorder, anxiety and depression in resistant hypertension — a case — control study. J Hypertens. 1997; 15(10): 1077–1082.
  14. Pohl R, Yeragani VK, Balon R, et al. Isoproterenol-induced anxiety states. Psychopharmacol Bull. 1985; 21(3): 424–427.
  15. Anxiety Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders.
  16. Jorge RE. Posttraumatic stress disorder. Continuum (Minneap Minn). 2015; 21(3 Behavioral Neurology and Neuropsychiatry): 789–805.
  17. Mamilla D, Gonzales M, Esler M, et al. Pseudopheochromocytoma. Endocrinol Metab Clin North Am. 2019; 48(4): 751–764.
  18. Tykarski A, Filipiak KJ, Januszewicz A, et al. Zasady postępowania w nadciśnieniu tętniczym — 2019 rok. Nadciśnienie Tętnicze w Praktyce. 2019; 5(1): 1–86.
  19. Williams B, Mancia G, Siering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–104.
  20. Garcha A, Cohen D. Catecholamine Excess: Pseudopheochromocytoma and Beyond. Adv Chronic Kidney Dis. 2015; 22(3): 218–223.

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