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Paroxysmal hypertension
1
Transcript
Paroxysmal hypertension
Most High Yield!!!!
Differentials
Paroxysmal hypertension
Subtype : Pheochromocytoma + Pseudopheochromocytoma
Dresseler's syndrome --> autoimmune pericarditis usually occur after damage to heart tissue or the pericardium (e.g. silent heart attack, trauma, ...
- Twenty-four-hour urine test: A test in which urine is collected for 24 hours to measure the amounts of catecholamines in the urine.
- Blood catecholamine studies: A procedure in which a blood sample is checked to measure the amount of certain catecholamines released into the blood.
- CT or MRI to visualize the tumor
Observe: pain relieved with leaning forward+ Diffuse ST elevation + PR depression in majority of Leads on ECG
Treatment
Pseudopheochromocytoma
- surgical resection of the tumor
- Patients with paroxysmal hypertension who test negative for pheochromocytoma --> "pseudopheochromocytoma."
- adrenalectomy
- pseudopheochromocytoma ( page's syndrome) is caused predominantly by episodic dopamine discharge,
- stressors including pain or anxiety, or possibly repressed emotions + mismanagement of stress
- give phenoxybenzamine before surgery to prevent intraoperative hypertension
- the cause remains unknown, treatment is difficult + can lead to chronic disability.
Paroxysmal Hypertension
Our Patient
- Episodic and volatile high blood pressure, which may be due to -->
- epigastric pain
- Pseudopheochromocytoma
Pheochromocytoma
- neuroendocrine tumor of the medulla of the adrenal gland
- Hypertension
- Pheochromocytoma
- secretes catecholamine--> mostly norepinephrine mainly + some epinephrine
Paraganglioma (Extraedrenal pheochromocytoma)
- Headaches
- neuroendocrine tumor at different body sites other than adrenal gland
- constipation
- Diaphoresis
- Eat chocolate, greasy,cheesy food
- stressed + agitated
- same symptoms as our patient + pheochromocytoma get exacerbated by food that is rich in Tyramine (trace amine naturally derived from Tyrosine (cheese, chocolate,..)
Our patient has change in BP taking + epigastric pain+ other symtoms
- some genetic association in the family such as MEN2A + MEN2B
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