Wednesday, January 27, 2010

TOPIC DISCUSSION: Pseudopheochromocytoma

Pseudopheochromocytoma is a real disease. Dr. Sam Mann from Cornell has written a lot about this disease.  It causes paroxysmal Hypertension.  98% of people with paroxysmal hypertension do not have pheochromocytoma. The cause and management of paroxysmal hypertension remain a mystery, and the subject of remarkably few papers. Patients experience symptomatic blood pressure surges likely linked to sympathetic nervous system stimulation. A specific personality profile( likely of some abuse as a child) associated with this disorder suggests a psychological basis, attributable to repressed emotion related to prior emotional trauma or a repressive (nonemotional) coping style. Based on this understanding, three forms of intervention, alone or in combination, appear successful: antihypertensive therapy with agents directed at the sympathetically mediated blood pressure elevation (eg, combined α- and β-blockade or central α-agonists such as clonidine); psychopharmacologic interventions including anxiolytic and/or antidepressant agents; and psychological intervention, particularly reassurance and increased psychological awareness. An appropriately selected intervention can reduce or eliminate attacks in most patients. Look for this disease in your patients. Its more common than we think.

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