FACTITIOUS PHEOCHROMOCYTOMA - NOVEL MIMICKRY BY VALSALVA MANEUVER ANDCLUES TO DIAGNOSIS

Factitious pheochromocytoma usually occurs in patients surreptitiously ingesting adrenergic medications. We encountered a case of factitious pheochromocytoma wherein the subject mimicked hemodynamic (profound h ypertension) and biochemical (plasma catecholamine elevation) manifest ations of the illness by consciously altering autonomic function with Valsalva maneuver. Clues to this presentation included visible perform ance of Valsalva maneuver, marked disparity between blood pressures re corded in the presence and absence of the subject's knowledge, normal urinary catecholamine and metabolite excretion, and normal plasma chro mogranin A. We reproduced, in part, the hemodynamic and biochemical ma nifestations of this presentation with Valsalva maneuver in healthy su bjects.