In differential diagnosis of panic-like episodes with hypertension, which condition should be considered?

• A. Pheochromocytoma
• B. Generalized Anxiety Disorder
• C. Obsessive-Compulsive Disorder
• D. Major Depressive Disorder

Answer: (A)

When a patient has panic-like episodes accompanied by hypertension, think about a cause beyond a primary anxiety disorder—specifically, a condition that causes episodic catecholamine excess. Pheochromocytoma fits this pattern because a tumor of chromaffin cells can release catecholamines in spells, producing sudden episodes of hypertension, tachycardia, sweating, headaches, and anxiety that mimic panic attacks.

Generalized Anxiety Disorder can produce prolonged worry and autonomic symptoms, but it typically lacks the discrete, episodic surges of blood pressure seen with pheochromocytoma. Obsessive-compulsive disorder and Major Depressive Disorder explain mood, thoughts, or behavior patterns rather than paroxysmal hypertension and the sweating-tachycardia cluster that accompanies catecholamine storms.

If pheochromocytoma is suspected, the next step is biochemical confirmation with plasma free metanephrines or urinary fractionated metanephrines, followed by imaging to locate the tumor if tests are positive. Treatment centers on blocking catecholamine effects with alpha-adrenergic blockade before considering surgical removal of the tumor.