AMBULATORY BLOOD-PRESSURE MONITORING IN DIAGNOSING A PHEOCHROMOCYTOMAOF THE URINARY-BLADDER - A CASE-REPORT

A patient is presented in whom the preoperative diagnosis of an intrav esical pheochromocytoma was facilitated by noninvasive ambulatory bloo d pressure monitoring. A fifty-two-year-old Japanese man suffered head ache and palpitation after micturition. Cystoscopy revealed an intrave sical tumor. To investigate whether his symptoms were associated with an elevation of blood pressure, the authors monitored his ambulatory b lood pressure automatically for twenty-four hours. The patient was als o instructed to activate the recording manually upon the onset of symp toms. As a result, elevations of blood pressure were apparent followin g micturition. The twenty-four-hour urinary excretion of norepinephrin e was elevated on the day of the blood pressure monitoring. Pheochromo cytoma was suspected and was confirmed by histopathologic studies foll owing the operation. Thus, ambulatory blood pressure monitoring may be useful in detecting the transient hypertension induced by micturition , which can provide preoperative evidence of pheochromocytoma of the u rinary bladder.