Pseudopheochromocytoma (severe paroxysmal hypertension) is often caused by activation of the sympathetic nervous system due to diverse etiologies (Mann SJ, Arch Int Med 159:670–74, 1999). A case is presented and the literature is reviewed.Design and method:
A 43-year-old male patient was referred to our outpatient clinic because of periodically elevated systolic pressures values with peaks of 250 mmHg which had been going on for several years. In the past, he repeatedly had refused hospital emergency admission. On physical examination he presented in good clinical condition; height 202 cm; body weight 121 kgs. There were no clinical signs of secondary forms of hypertension and no retinopathy. His blood pressure values on monotherapy with an AT1-blocking was 177/108 mmHg with a regular heart rate of 86 beats per minute (bpm). On this medication 24-hr-blood pressure monitoring revealed a mean daytime pressure of 190/120 mmHg and a mean nighttime pressure of 153/99 mmHg with corresponding mean heart rates of 82 and 64 bpm, respectively. Extensive work-up for secondary hypertension did not reveal any abnormality (including Doppler investigation for renal artery stenosis, urinary catecholamines, free plasma metanephrines, aldosterone/renin ratio, renal function tests). His urinary sodium was in the high range (244 mmol/24hrs) with no proteinuria.Results:
Antihypertensive management was gradually intensified to standard triple therapy. Upon psychological evaluation an antidepressant was prescribed. Thereafter, his blood pressure values were persistently in the normal range.Conclusions:
This case and review of the related literature show that severe paroxysmal hypertension is not uncommon, often requiring extensive work-up and specialized therapeutic strategies. However, no generally accepted clinical management guideline has yet emerged. Based on this report a practical approach to this clinical syndrome will be presented.