HYPERDYNAMIC β-ADRENERGIC CIRCULATORY STATE WITH MARKEDLY LABILE HYPERTENSION

Abstract

Herein reported is a case of hyperdynamic β-adrenergic circulatory state in a 47-year-old woman with attacks of paroxysmal palpitation, tachycardia, sweating, fatigue and hypertension. Her history dates back to 24 years of her age when the first episode appeared during her first pregnancy. The attack became more frequent and was easily provoked by tightening her waist. She was admitted with the diagnosis of possible pheochromocytoma which was excluded by the fact that the laboratory data and pharmacological tests failed to show the hypersecretion of catecholamines. Careful observation revealed the attack was provoked not only by abdominal compressions but also by quick postural changes. Tilting test showed a transient hypotension followed by severe palpitation and tachycardia with various other symptoms constituting her episode.
It appeared that her symptoms were due to increased β-adrenergic receptor reactivity as had been proposed by Frohlich et al. and Miyahara et al. The administration of adrenergic β-blocking agent, propranolol, was dramatically effective.
Since the elevation of blood pressure induced by left flank massage was consistently higher than that by right flank compression, exploratory laparotomy was performed in order to exclude the pseudopheochromocytoma syndrome. Surgery revealed no abnormal findings including bilateral adrenal gland.
It would be important for the urologists to appreciate this syndrome because some of the patients with paroxysmal hypertension masquerading pheochromocytoma might suffer from this syndrome which could be treated by adrenergic β-blockers.