Pheochromocytoma vs. Panic Disorder: Identifying the Cause of Sudden Hypertensive Crises and Intense Anxiety

Sudden episodes of intense anxiety and hypertensive crises can be symptoms of various medical conditions, prominently including pheochromocytoma and panic disorder. Although both may present similar symptoms such as palpitations, sweating, and anxiety, it is crucial to differentiate them for appropriate treatment. This article explores the distinctive characteristics of each condition and provides a guide for differential diagnosis.

Diving into Differential Diagnosis

Pheochromocytoma is a rare tumor of the adrenal gland that secretes catecholamines, such as adrenaline and noradrenaline, leading to symptoms of hypertensive crises and intense anxiety. While the classic triad includes headache, palpitations, and sweating, anxiety is also a common symptom, often confused with panic disorder. A reported case describes a patient experiencing severe anxiety for thirteen years before being diagnosed with pheochromocytoma, highlighting the importance of considering this condition in refractory anxiety diagnoses.

On the other hand, panic disorder is characterized by recurrent and sudden panic attacks, which may include physical symptoms similar to those of pheochromocytoma. However, unlike pheochromocytoma, there is no excessive secretion of catecholamines. In some cases, patients with panic disorder may experience episodes of paroxysmal hypertension, but without the presence of an underlying tumor.

The differential diagnosis relies on laboratory tests and imaging studies. Measuring catecholamines in urine and plasma is essential to confirm or rule out pheochromocytoma. In contrast, the diagnosis of panic disorder is primarily based on clinical evaluation and the exclusion of other organic causes.

Conclusions

Differentiating between pheochromocytoma and panic disorder is fundamental for the proper management of patients presenting with sudden episodes of intense anxiety and hypertensive crises. While pheochromocytoma requires surgical intervention and specific medical management, panic disorder is treated with cognitive-behavioral therapy and anxiolytic medication. Careful evaluation and the use of appropriate diagnostic tests are essential to avoid misdiagnosis and provide the most effective treatment.

Referencias

• [1] Unusual presentation of pheochromocytoma: thirteen years of anxiety requiring psychiatric treatment
• [2] Cardiogenic shock in a 61 year old female with recurrent panic attacks
• [3] Severe paroxysmal hypertension (pseudopheochromocytoma)

Created 6/1/2025