EXTREME BLOOD-PRESSURE FLUCTUATIONS IN A PATIENT WITH INTACT AUTONOMIC REFLEXES AND INTACT SODIUM CONSERVATION

A patient who had episodes of profound hypotension alternating with se vere hypertension without an obvious precipitating cause is reported, The hypotensive episodes were accompanied by tiredness, syncope, brady cardia, and a low norepinephrine concentration while supine or standin g, In contrast, the hypertensive episodes were associated with marked tachycardia, sweating, anxiety, abdominal pain, and very high levels o f plasma norepinephrine concentration. Extensive investigations failed to support a diagnosis of pheochromocytoma. The testing of barorecept or function and autonomic reflexes was normal. Blood pressure was not salt sensitive. It was concluded that this patient has a unique clinic al syndrome of extreme fluctuation of blood pressure and sympathetic n ervous activity yet intact cardiovascular reflexes and normal sodium c onservation, The abnormal blood pressure regulation most likely has a central origin.