title: Catecholamine excess: pseudopheochromocytoma and beyond.
abstract: Symptoms of catecholamine excess or pseudopheochromocytoma can be clinically indistinguishable from pheochromocytoma. Patients usually present with paroxysmal or episodic hypertension and have a negative evaluation for pheochromocytoma. It is important to exclude other causes of catecholamine excess that can be induced by stress, autonomic dysfunction due to baroreflex failure, medications, and drugs. Patients with pseudopheochromocytoma appear to have an amplified cardiovascular responsiveness to catecholamines with enhanced sympathetic nervous stimulation. The exact mechanism is not well understood and increased secretion of dopamine, epinephrine, and norepinephrine, and their metabolites have been identified as potentiating this clinical scenario leading to differing hemodynamic presentations depending on which catecholamine is elevated. Management of this condition is often difficult and frustrating for both the physician and the patient. Most patients respond reasonably well to medications that reduce sympathetic nervous system activity. Anxiolytics, antidepressants, and psychotherapy also play an important role in managing these patients' symptoms.
authors.affiliation: Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Amarinder S
authors.initials: AS
authors.lastname: Garcha
authors.affiliation: Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: debbie.cohen@uphs.upenn.edu.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D018663:Adrenergic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D018660:Blood Pressure Monitoring, Ambulatory; D002395:Catecholamines / Q000378:metabolism*; D003000:Clonidine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D016584:Panic Disorder / Q000175:diagnosis; D010673:Pheochromocytoma / Q000175:diagnosis; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis
chemical_list: D018663:Adrenergic Agents; D000959:Antihypertensive Agents; D002395:Catecholamines; D003000:Clonidine
keywords: Catecholamine excess; Labile hypertension; Pheochromocytoma; Pseudopheochromocytoma; Renalase