Unexplained Symptomatic Paroxysmal Hypertension: a Diagnostic and Management Challenge

  • Kelly DyerEmail author
  • Theresa E. Vettese
Clinical Practice: Clinical Vignettes


Symptomatic paroxysmal hypertension is considered the hallmark symptom of pheochromocytomas. Pheochromocytomas, however, are exceedingly rare and are diagnosed in 2% of patients with hypertensive paroxysms.1 As a result, clinicians and patients are often left frustrated and confused when a diagnostic evaluation of symptomatic paroxysmal hypertension is un-revealing for a pheochromocytoma. Frequently, these patients undergo multiple and often unnecessary testing, as was the case with our patient. The differential diagnosis is broader than most clinicians realize and includes conditions such as prescription and illicit drug use, obstructive sleep apnea, panic attacks, and pseudopheochromocytoma. Of these, pseudopheochromocytoma is perhaps the least understood and considered.


A 58-year-old woman with a past medical history of well controlled HIV and a diagnosis of seizure disorder presented with severe hypertension and headache. According to the patient’s husband, she...



There were no further contributors to the paper. Contributors all met criteria for authorship.

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Conflict of Interest

The authors declare that they do not have a conflict of interest.


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© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Division of General Medicine and Geriatrics, Department of MedicineEmory University School of MedicineAtlantaUSA

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