Severe Paroxysmal Hypertension (Pseudopheochromocytoma)

Abstract

Severe, symptomatic paroxysmal hypertension always generates suspicion of a pheochromocytoma, a catecholamine-secreting tumor. However, most patients with this disorder do not have this tumor and their condition remains undiagnosed and ineffectively treated. This case series, summarizing the course of 21 such patients, suggests a cause and an effective treatment approach. All 21 patients insisted that the paroxysms were not related to stress or emotional distress, initially discouraging consideration of a link to emotions. Nevertheless, with careful psychosocial interviewing, the disorder could be attributed to emotions patients were not aware of, and, therefore, unable to report. Such emotions were related either to previous severe emotional trauma or to a general tendency to keep distressful emotions out of awareness. With treatment based on this understanding, further paroxysms were eliminated in 13 (62%) of 21 patients. Alpha- plus beta-blockade was used, combined, when necessary, with an antidepressant agent, with or without an anxiolytic agent. In 3 cases, the disorder was cured with psychotherapy alone. Because the presenting symptoms are physical rather than emotional, patients present to internists and primary care physicians rather than to psychotherapists. For this reason, more awareness of this disorder in the medical community is needed.

Chronic stress and brain plasticity: Mechanisms underlying adaptive and maladaptive changes and implications for stress-related CNS disorders

“…Characterization of each of these can be a matter of perspective and context (Herman, 2013). Stress responses promote survival by helping organisms meet the demands of a variety of acute challenges in the short-term (Huether, 1996; Levine and Ursin, 1991; McEwen, 2004; Ursin and Olff, 1993), yet they are also linked with impaired functioning and the development of pathology under repeated activation or extended conditions (Chrousos, 2000; Mann, 1999; McEwen, 2000; Pasternac and Talajic, 1991; Paykel, 1976; Shively et al, 2009; Vanitallie, 2002). One popular formulation of maladaptation is allostatic load, and refers to the cumulative effects or "costs" generated following repeated stress exposure on multiple physiologic systems (Brindley and Rolland, 1989; McEwen and Stellar, 1993).…”

Pseudopheochromocytoma Associated with Domestic Assault

“…Clinically, hypertension episodes are usually sudden in onset and are often accompanied by physical symptoms including headaches, dizziness, nausea, diaphoresis, chest pain, and palpitations [ 2 ] which are indistinguishable from the symptoms observed in a patient with pheochromocytoma. Frequency of these episodes ranges from daily to less than one per month and the duration of the episodes may range from minutes to days [ 4 ].…”

“…Frequency of these episodes ranges from daily to less than one per month and the duration of the episodes may range from minutes to days [ 4 ]. In their series of 21 patients, Mann found that women are more often affected than men [ 2 ] and that the majority of patients had 1–3 attacks per week. The most frequent symptoms were chest pain (80%) followed by light-headedness (68%), headache (68%), nausea, and diaphoresis (62%).…”

“…However, Kuchel described patients with paroxysmal hypertension without catecholamines overproduction [ 1 ]. This entity called “pseudopheochromocytoma” is characterized by paroxysmal and abrupt onset of hypertension with symptoms (headache, chest pain, dizziness, nausea, flushing, and palpitations) which is not induced by fear or panic [ 2 ]. Moreover in the majority of cases, a past history of severe emotional trauma is found such as physical or psychological violence [ 2 ].…”

A Man with Labile Blood Pressure

“…Other causes of paroxysmal hypertension include labile hypertension, hyperthyroidism, renovascular hypertension, seizure disorder, migraine, alcohol withdrawal, drugs such as cocaine, amphetamines, or clozapine [2], carcinoid syndrome, panic disorder, and baroreflex failure [3]. In some cases of paroxysmal hypertension, no obvious cause could be identified, though it has been suggested that careful psychosocial interviewing may uncover repressed emotional distress that patients may not be aware of [4]. …”