Severe paroxysmal hypertension (pseudopheochromocytoma) - Understanding the cause and treatment

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 undia gnosed 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 e motional distress, initially discouraging consideration of a link to emotio ns. Nevertheless, with careful psychosocial interviewing, the disorder coul d be attributed to emotions patients were not aware of, and, therefore, una ble to report. Such emotions were related either to previous severe emotion al trauma or to a general tendency to keep distressful emotions out of awar eness. With treatment based on this understanding, further paroxysms were e liminated in 13 (62%) of 21 patients. alpha- plus beta-blockade was used, c ombined, when necessary, with an antidepressant agent, with or without an a nxiolytic agent. In 3 cases, the disorder was cured with psychotherapy alon e. Because the presenting symptoms are physical rather than emotional, pati ents present to internists and primary care physicians rather than to psych otherapists. For this reason, more awareness of this disorder in the medica l community is needed.