History Symptomatic paroxysmal hypertension without significantly elevated catecholamine concentrations and without proof an fundamental adrenal tumor is recognized as pseudopheochromocytoma. which the withdrawal of the anxiolytic therapeutic program may generate sympathetic overdrive leading to life-threatening paroxysmal malignant hypertension and supplementary encephalopathy. We emphasize that pseudopheochromocytoma could TAK-438 be diagnosed just after exclusion from the supplementary factors behind hypertension. We KIAA0243 showcase the need for a psychopharmacological method of this scientific entity. Keywords: Anxiolytic medicines Pseudopheochromocytoma Hypertension Psychopharmacology Background Pseudopheochromocytoma can be a rapid starting point of the constellation of symptoms generated by sympathoadrenal overdrive [1 2 Generally this clinical symptoms contains paroxysmal (malignant) hypertension tremor palpitation sweating upper body pain headaches nausea dizziness and pseudoseizures [3-5]. The episodes of clinical complaints and symptoms may last from short minutes up to hours. Importantly the essential difference between pheochromocytoma and pseudopheochromocytoma can be that in the second option no biochemical and anatomical history could be clarified; nevertheless proof gentle to moderate catecholamine release may be tested during the paroxysms [6-9]. It’s been suggested a number of elements interact resulting in the development of the clinical condition in virtually any one person (Desk?1). Furthermore you can find differences in the severe nature and clinical features between individuals that may bring about the variety of pseudopheochromocytoma [10]. Oddly enough besides the currently known medical causes psychological years as a child traumas could also play a role in the genesis of this clinical entity where psychotherapy can effectively relieve symptoms [11]. Furthermore it has to be emphasized that this condition may be secondary to certain drug therapies (for example sympathomimetic agents tricyclic antidepressants or reboxetine) all of which can contribute to the emergence of sympathetic overdrive [12-14]. However it has not been clearly elucidated whether the modification or the termination of a former psychopharmacological therapy may be able to generate such severe symptoms leading to the diagnosis of pseudopheochromocytoma [15]. Throughout our work we aimed to clarify the role of the withdrawal of the anxiolytic drug alprazolam in the genesis of the characteristic clinical features of pseudopheochromocytoma by presenting one of our patients’ clinical history. Table 1 Various clinical conditions can present in a similar way to pseudopheochromocytoma Case presentation In January 2014 a 55-year-old Caucasian TAK-438 woman was admitted to our Emergency Unit with paroxysmal malignant hypertension accompanied by headache vertigo tachycardia lacrimation nausea and altered mental status. Her medical history included a TAK-438 caesarean section (1984) an abdominal surgery due to mechanical ileus a laparoscopic cholecystectomy (1995) gastro-oesophageal reflux TAK-438 and a total thyroidectomy due to a benign non-toxic multi-nodular goiter later requiring thyroid hormonal substitution. In 2008 an elevated fasting glucose level pointed to an underlying type 2 diabetes mellitus. Hypertension and sinus tachycardia was first diagnosed in 2003. Consequently the patient underwent several examinations in various hospitals but no underlying organic causes of her complaints could be detected. Endocrinological disorders – especially pheochromocytoma – were excluded on several occasions. Her altered mental status during the hypertensive crises raised the possibility of neurological deficiency but no signs of intracranial tumor cerebral vascular lesion hemorrhage or even epilepsy were detectable. Moreover cardiac arrhythmias and ischemic heart disease were also excluded. In 2004 after numerous diagnostic procedures panic syndrome was diagnosed Eventually; anxiolytic and antidepressant medications were initiated therefore. Between 2004 and 2013 the individual was treated with this mix of psychopharmacological real estate agents. During a comprehensive psychiatric follow-up period the rate of recurrence from the paroxysms lowered noticeably however the patient appeared to be dependent on the psychopharmacological routine so the medicines had been withdrawn in another middle. During TAK-438 the pursuing year the individual did not display any medical symptoms of paroxysmal hypertension. During the current entrance to our center the patient’s medical therapy contains metoprolol 100?mg daily esomeprazole 40 twice?mg daily levothyroxine 100?μg.