Clinical findings associated with excess epinephrine:
(1) headache
(2) tremor
(3) tachycardia
(4) hypertension
Findings that may suggest factitious disease:
(1) history of anxiety, depression or drug abuse
(2) close contact with health care (self, friend or relative)
(3) evidence of self-injection
(4) history of factitious disease
(5) history of multiple previous physicians, hospitalizations and/or surgery
Laboratory findings:
(1) elevated serum levels of epinephrine
(2) serum levels of epinephrine vary markedly between different samples
(3) normal serum norepinephrine levels
(4) normal clonidine suppression test
(5) normal serum chromogranin A levels
(6) increased urinary epinephrine levels
(7) low to normal urinary norepinephrine and catecholamine metabolite levels
Imaging studies:
(1) The adrenal glands show a normal size on CT or MRI scans.
(2) A scan with 131-metaiodobenzylguanidine (131-MIBG) is normal.
Differential diagnosis:
(1) A pheochromocytoma that only secretes epinephrine.
(2) Extra-adrenal pheochromocytoma (10% of pheochromocytomas).
