Catecholamine excess: pseudopheochromocytoma and beyond

Adv Chronic Kidney Dis. 2015 May;22(3):218-23. doi: 10.1053/j.ackd.2014.11.002.

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.

Keywords: Catecholamine excess; Labile hypertension; Pheochromocytoma; Pseudopheochromocytoma; Renalase.

Publication types

  • Review

MeSH terms

  • Adrenal Gland Neoplasms / diagnosis
  • Adrenergic Agents / therapeutic use*
  • Antihypertensive Agents / therapeutic use
  • Autonomic Nervous System Diseases / complications
  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / drug therapy
  • Autonomic Nervous System Diseases / metabolism*
  • Blood Pressure Monitoring, Ambulatory
  • Catecholamines / metabolism*
  • Clonidine / therapeutic use
  • Diagnosis, Differential
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / etiology
  • Hypertension / metabolism*
  • Panic Disorder / diagnosis
  • Pheochromocytoma / diagnosis
  • Stress Disorders, Post-Traumatic / diagnosis

Substances

  • Adrenergic Agents
  • Antihypertensive Agents
  • Catecholamines
  • Clonidine