Pseudophaeochromocytoma

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As paroxysmal hypertension (severe paroxysmal arterial hypertension, essential hypertension hyperadrenerge) refers to a syndrome that is characterized by paroxysmal severe hypertension and in which pheochromocytoma was excluded. Pseudophaeochromocytoma is much more common than pheochromocytoma. Such paroxysmal increases in blood pressure are also observed after emotional stress and trauma . Treatment then takes the form of psychotherapy and combination drug therapy in which alpha and beta blockers as well as antidepressants and anxiolytics are used.

causes

In addition to emotional trauma, there are several other causes of severe paroxysmal arterial hypertension. For example, it is being discussed that obstructive sleep apnea syndrome could be a rare cause.

A connection with various drugs is also being discussed, including clozapine and toloxatone , terbutaline and phenylephrine .

Symptoms and diagnosis

In patients with severe attacks of high blood pressure that are accompanied by pronounced symptoms such as headache , chest pain , dizziness , nausea , palpitations , flushing and sweating , a stress hormone- producing tumor of the adrenal gland , a pheochromocytoma, must be considered. In the vast majority of cases, a pheochromocytoma can be reliably excluded by determining the metanephrines in serum and / or urine .

The episodes are described as starting abruptly and are not triggered by stress , distressing emotions, fear or panic . The seizures last from half an hour to several hours and can lead to fatigue lasting one to two days. The frequency of seizures ranges from one episode in several months to one or two episodes per day. Usually the blood pressure exceeds values ​​of 200/110 mmHg. Blood pressure is normal or slightly increased between attacks. Usually the quality of life of those affected is significantly impaired.

Differential diagnosis

Psychosomatic basics

A previous emotional trauma can often be uncovered through a psychosocial interview (Holocaust, emotional or physical abuse) without experiencing stressful emotions in connection with the trauma. This suggests emotional defense mechanisms such as dissociation or repression . If no previous emotional trauma can be determined, those affected often find an attitude in which stressful emotions are barely perceived.

therapy

The treatment takes place through psychotherapy as well as medication through the combined administration of alpha and beta receptor blockers , possibly in combination with an antidepressant and possibly an anxiolytic .

Individual evidence

  1. ↑ H. Kahal, AA Tahrani, JT George, IM Barlow, MA Malik: Obstructive sleep apnea; a rare cause of pseudophaeochromocytoma. In: QJM . 106, 2013, pp. 1133-1136, doi : 10.1093 / qjmed / hcr216 .
  2. ↑ O. Akinsola, K. Ong: Pseudophaeochromocytoma associated with Clozapine Therapy: a case report. In: African Journal of Psychiatry. 14, 2011, S., doi : 10.4314 / ajpsy.v14i5.9 .
  3. ↑ AJ Krentz, S. Mikhail, P. Cantrell, GM Hill: Drug Points: Pseudophaeochromocytoma syndrome associated with clozapine. In: BMJ (Clinical research ed.). Volume 322, Number 7296, May 2001, p. 1213, ISSN  0959-8138 . PMID 11358774 . PMC 31620 (free full text).
  4. ↑ H. Lefebvre, R. Richard, C. Noblet, N. Moore, LM Wolf: Life-threatening pseudophaeochromocytoma after toloxatone, terbutaline, and phenylephrine. In: Lancet. Volume 341, Number 8844, February 1993, pp. 555-556, ISSN  0140-6736 . PMID 8094790 .

literature

archinte.ama-assn.org (PDF)
  • Samuel J Mann: Severe paroxysmal hypertension (pseudopheochromocytoma) . In: Current Hypertension Reports . 10, No. 1, February 2008, ISSN  1534-3111 , pp. 12-18. PMID 18367021 .