Background: Although phaeochromocytoma is commonly considered in the differential diagnosis paroxysmal hypertension, only a small percentage of patients are actually diagnosed with this disorder. After exclusion of phaeochromocytoma, panic attack and pseudophaeochromocytoma should be considered in the differential diagnosis in patients with these symptoms. Here we report a rare case of pseudophaeochromocytoma presented with severe symptomatic hypertension attacks.
Case: A 16-year-old boy was referred due to attacks of hypertension associated with palpitation with a suspected diagnosis of phaeochromocytoma. He had symptoms of sudden-onset headache, palpitation, chest pain and dyspnoea attacks which could occur even at rest for the past 6 months. Occasionally, these symptoms associated with severe hypertension (>99 p+5 mmHg) and flushing. Medical history revealed antidepressant and antipsychotic drug usage for his symptoms. On physical examination; his height was 182 cm (>97 p), weight 113 kg (>97 p), BMI 34 k/m2 (>97 p) blood pressure 110/80 mmHg. He had acanthosis nigricans on axillary and cervical regions. Renal, cardiac, cerebral and endocrinological causes of hypertension including hyperthyroidism, hyperaldosteronism and cushing syndrome were excluded. There were no findings of end-organ damage. On 24-h monitoring, mean and maximum blood pressure measurements were 137/86 mmHg (9597 p) and 153/92 mmHg (>99 p+5 mmHg) respectively. Despite enalapril treatment, he had hypertensive attacks. Plasma and 24-h-urinary catecholamine levels and metanephrine levels were within normal levels. MIBG scanning was also normal. After exclusion of phaeochromocytoma, pseudophaeochromocytoma was considered in this patient.
Conclusion: In the differential diagnosis of paroxysmal hypertension, phaeochromocytoma should be considered first and investigated thoroughly. However, pseudophaeochromocytoma should be kept in mind in patients clinically suggesting phaeochromocytoma but with no laboratory findings.
01 Oct 2015 - 03 Oct 2015