Severe paroxysmal hypertension (pseudopheochromocytoma) is a condition with episodic hypertension of uncertain origins that may be confused with pheochromocytoma.


Frequency of episodes: may range from hours to months


Duration of episodes: may range from minutes to days


Blood pressure during an episode: increased above usual levels, may have a systolic blood pressure >= 200 and diastolic blood pressure >= 110


The onset of hypertension and clinical symptoms is abrupt.


Clinical features during an attack:

(1) chest pain

(2) feeling of lightheadedness

(3) shortness of breath (dyspnea)

(4) weakness

(5) flushing

(6) nausea

(7) sweating (diaphoresis)

(8) headache

(9) palpitations

(10) moderate to severe impairment

(11) exhaustion after the episode


Features that distinguish it from a pheochromocytoma:

(1) plasma epinephrine levels during an attack are normal or only mildly increased

(2) a significant increase in blood pressure during phase IV of the Valsalva maneuver


Other conditions to exclude:

(1) stimulant abuse

(2) panic attack

(3) medications


Mann proposes that many cases are due to suppression of strong emotions. Hamada et al proposed that the increase in blood pressure during a Valsalva maneuver was due to hyperactivity of both beta and alpha-1 adrenergic receptors.


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