Endocrine Abstracts

Introduction: Pseudopheochromocytoma is a poorly comprehended entity believed to arise from an overstimulated sympathetic nervous system. Individuals with pseudopheochromocytoma seem to demonstrate heightened cardiovascular reactivity to catecholamines, along with an increased release of epinephrine from the adrenal glands in response to stimulation from the sympathetic nervous system. This clinical report presents an observation of pseudopheochromocytoma in a patient diagnosed with a depressive disorder.

Case Presentation: A 29-year-old patient was admitted to our endocrinology department for the evaluation of hypertension. The onset of his medical history dates to the age of 18-year-old, when he was receiving psychiatric care for depression. The patient's clinical course revealed a sudden-onset hypertension, palpitations, and headache lasting for few minutes followed by spontaneous resolution. He noted a worsening of blood pressure while on antidepressants medications. We conducted a 24-hour ambulatory blood pressure monitoring, revealing consistently normal blood pressure levels interspersed with two episodes of elevated systolic blood pressure reaching 140 mmHg. Investigations have ruled out renal artery stenosis. Aldosterone (257 pg/ml [42-209]) and direct renin (17.7 pg/ml [2.7-16.5]) levels were in favor of secondary hyperaldosteronism. Urinary normetanephrines were mildly elevated, below twice the upper limit of normal (Metanephrines: 276 nmol/24 h [<159 nmol/24 h]). 3-methoxytyramine were mildly elevated. Repeating metanephrines in the plasma after 30 min rest showed normal result and the abdominal CT-scan eliminated adrenal tumors.

Discussion: Pseudopheochromocytoma is characterized by the presence of symptoms of catecholamine excess and is commonly considered as a diagnosis of exclusion, yet it possesses distinct characteristics. It is strongly linked to psychiatric disorder, which may not be immediately apparent. Pharmacological approaches for managing this condition encompass antihypertensive medications, antidepressants, and anxiolytics. Additionally, psychotherapeutic interventions prove beneficial in addressing this association. The management of pseudopheochromocytoma is frequently challenging.