# Pseudopheochromocytoma With Catecholamine Excess and End-organ Damage: A 30-year Course Treated With Escitalopram

## TL;DR

A 70-year-old woman with long-term high blood pressure and symptoms similar to a rare tumor was found to have a stress-related condition that improved with therapy and medication.

## Contribution

This case highlights the successful treatment of pseudopheochromocytoma using escitalopram and psychotherapy.

## Key findings

- Imaging ruled out pheochromocytoma or paraganglioma in the patient.
- Escitalopram and psychotherapy significantly reduced the patient's hypertensive episodes.
- The case emphasizes the importance of considering stress-related conditions in diagnosing hypertension.

## Abstract

Pseudopheochromocytoma is a disorder characterized by paroxysmal hypertension and variably elevated catecholamine metabolite levels. Pseudopheochromocytoma clinically mimics pheochromocytoma but differs in etiology. While pheochromocytoma is a catecholamine-secreting neuroendocrine tumor, pseudopheochromocytoma is a syndrome linked to a history of emotional stressors and is believed to stem from autonomic nervous system dysregulation. We present the case of a 70-year-old female patient experiencing episodic hypertensive crises for 3 decades. The patient was referred to endocrine oncology for evaluation of a possible pheochromocytoma due to her long-standing history of symptomatic hypertension and elevated catecholamine metabolites. Anatomic and functional imaging, including computed tomography scans of the abdomen and pelvis and a 64Copper-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-octreotate positron emission tomography computed tomography excluded a diagnosis of pheochromocytoma or paraganglioma. Her history of significant emotional stressors raised the possibility of pseudopheochromocytoma. Following initiation of escitalopram and psychotherapy, the patient experienced a remarkable improvement in the frequency and severity of hypertensive episodes. This case illustrates the diagnostic challenges of pseudopheochromocytoma and the importance of early intervention in preventing complications.