Despite multiple treatment modalities, a patient continues to have elevated chro

Question

Despite multiple treatment modalities, a patient continues to have elevated chronic hypertension for the last 6 months. Blood tests indicate normal aldosterone and antidiuretic hormone levels, but demonstrate markedly increased epinephrine and norepinephrine levels. Which of the following secondary causes of hypertension could explain his failure to respond to treatment?

Neoplasm of the adrenal medulla

Hypoglycemia from diabetes mellitus

High cortisol levels due to Cushing Syndrome

Obstruction of blood flow to the kidneys

Explanation / Answer

Answer: Neoplasm of the adrenal medulla

A markedly increased epinephrine and norepinephrine level occurs in neoplasm of adrenal medulla, otherwise named as Pheochromocytoma.

Pheochromocytoma /tumor of chromaffin tissue produces excessive quantities of catecholamines. Norepinephrine most frequently elevated.

Symptoms – Hypertension, headaches (from hypertension), sweating , anxiety, palpitations, and chest pain, orthostatic hypotension

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