title: Pseudopheochromocytoma induced by anxiolytic withdrawal.
abstract: BACKGROUND
  Symptomatic paroxysmal hypertension without significantly elevated catecholamine concentrations and with no evidence of an underlying adrenal tumor is known as pseudopheochromocytoma.
  
  
  METHODS
  We describe the case of a female patient with paroxysmal hypertensive crises accompanied by headache, vertigo, tachycardia, nausea and altered mental status. Previously, she was treated for a longer period with alprazolam due to panic disorder. Causes of secondary hypertension were excluded. Neurological triggers (intracranial tumor, cerebral vascular lesions, hemorrhage, and epilepsy) could not be detected.
  
  
  RESULTS
  Setting of the diagnosis of pseudopheochromocytoma treatment was initiated with alpha- and beta-blockers resulting in reduced frequency of symptoms. Alprazolam was restarted at a daily dose of 1 mg. The patient's clinical condition improved rapidly and the dosage of alpha- and beta-blockers could be decreased.
  
  
  CONCLUSIONS
  We conclude that the withdrawal of an anxiolytic therapeutic regimen may generate sympathetic overdrive resulting in life-threatening paroxysmal malignant hypertension and secondary encephalopathy. We emphasize that pseudopheochromocytoma can be diagnosed only after exclusion of the secondary causes of hypertension. We highlight the importance of a psychopharmacological approach to this clinical entity.
authors.forename: Alida
authors.initials: A
authors.lastname: Páll
authors.forename: Gergely
authors.initials: G
authors.lastname: Becs
authors.forename: Annamária
authors.initials: A
authors.lastname: Erdei
authors.forename: Lívia
authors.initials: L
authors.lastname: Sira
authors.forename: Arpád
authors.initials: A
authors.lastname: Czifra
authors.forename: Sándor
authors.initials: S
authors.lastname: Barna
authors.forename: Péter
authors.initials: P
authors.lastname: Kovács
authors.forename: Dénes
authors.initials: D
authors.lastname: Páll
authors.forename: György
authors.initials: G
authors.lastname: Pfliegler
authors.forename: György
authors.initials: G
authors.lastname: Paragh
authors.affiliation: Division of Emergency Medicine, Institute of Internal Medicine, University of Debrecen Medical Center, Nagyerdei krt, 98, Debrecen, 4032, Hungary. szaboz.med@gmail.com.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabó
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000139:chemically induced / Q000150:complications / Q000473:pathology*; D000525:Alprazolam / Q000008:administration & dosage / Q000009:adverse effects; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006261:Headache / Q000150:complications / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000150:complications / Q000473:pathology*; D008875:Middle Aged; D009325:Nausea / Q000150:complications / Q000473:pathology; D016584:Panic Disorder; D010673:Pheochromocytoma / Q000139:chemically induced / Q000150:complications / Q000473:pathology*; D013375:Substance Withdrawal Syndrome / Q000473:pathology*; D013610:Tachycardia / Q000150:complications / Q000473:pathology; D014717:Vertigo / Q000150:complications / Q000473:pathology
chemical_list: D014151:Anti-Anxiety Agents; D000525:Alprazolam