A 32-year-old woman presents to the emergency department with sudden episodes of severe anxiety, palpitations, profuse sweating, and a pounding headache. During one episode, her blood pressure is recorded at 210/110 mmHg. Between episodes, her blood pressure is normal. She has no prior psychiatric history. What is the most likely underlying medical cause of these symptoms?
- A Pheochromocytoma ✓
- B Hyperthyroidism
- C Panic disorder
- D Cushing syndrome
Correct answer: A. Pheochromocytoma
Explanation
Pheochromocytoma is a catecholamine-secreting tumor that causes episodic hypertension, palpitations, sweating, and severe anxiety or panic-like symptoms. The key discriminator from primary panic disorder is the markedly elevated blood pressure during the episodes. Panic disorder does not typically cause systolic pressures above 180 mmHg. Hyperthyroidism causes persistent symptoms, and Cushing syndrome presents with central obesity and striae.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
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Written and medically reviewed by the StethoPrep medical team.