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Brainstem tumour mimicking pheochromocytoma

Journal of Human Hypertension volume 23, pages 493–494 (2009)Cite this article

The diagnosis of a catecholamine-secreting pheochromocytoma is always suggested by occurrence of severe and symptomatic paroxysmal hypertension. However, in most patients this diagnosis is not confirmed, despite extensive investigation. 1 Traditionally, besides pheochromocytoma, the differential diagnosis in cases of paroxysmal hypertension associated with catecholamine excess should include cocaine use, antiparkinsonian drugs, obstructive sleep apnoea and baroreflex failure. 2 Nonetheless, when the paroxysmal hypertension is associated not only with catecholamine excess, but also with neurologic signs, a very rare differential diagnosis should also be considered: a brainstem tumour mimicking pheochromocytoma. 3, 4, 5

Mechanisms responsible for arterial hypertension in brainstem tumours include: raised intracranial pressure, increased catecholamine production and direct stimulation of the cardiovascular centre. In the only two other cases reported regarding brainstem tumours and hypertension, the cranial nerves were affected majorly on the left side, as also happened in our patient. This finding supports the hypothesis that compression/distortion of the left side of the medulla oblongata may result in arterial hypertension, which is probably due to a chronic hyperstimulation of the sympathetic nervous system induced by the compression of the rostral ventrolateral medulla, also known as the pressor area of the medulla oblongata.3, 5 It is noted that all earlier described cases, including this one, presented with neurological signs and symptoms; hence, the hypothesis of a brainstem tumour causing paroxysmal hypertension should not be considered if neurological signs and symptoms are not present.

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References

  1. Mann SJ . Severe paroxysmal hypertension (pseudopheochromocytoma). Curr Hypertens Rep 2008; 10: 12–18.

    Article  Google Scholar 

  2. Hunt J, Lin J . Paroxysmal hypertension in a 48-year-old woman. Kidney Int 2008; 74: 532–535.

    Article  Google Scholar 

  3. Evans CH, Westfall V, Atuk NO . Astrocytoma mimicking the features of pheochromocytoma. N Engl J Med 1972; 286: 1397–1399.

    Article  CAS  Google Scholar 

  4. Cameron SJ, Doig A . Cerebellar tumours presenting with clinical features of phaeochromocytoma. Lancet 1970; 1: 492–494.

    Article  CAS  Google Scholar 

  5. Pallini R, Lauretti L, Fernandez E . Chronic arterial hypertension as unique symptom of brainstem astrocytoma. Lancet 1995; 345: 1573.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Renal Division, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

    N C V Melo, L P F Carmo, C E Rodrigues, I D B Marques & J N Praxedes

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  1. N C V Melo
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  2. L P F Carmo
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  3. C E Rodrigues
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  4. I D B Marques
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  5. J N Praxedes
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Correspondence to N C V Melo.

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Melo, N., Carmo, L., Rodrigues, C. et al. Brainstem tumour mimicking pheochromocytoma. J Hum Hypertens 23, 493–494 (2009). https://doi.org/10.1038/jhh.2009.3

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