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Revista Virtual de la Sociedad Paraguaya de Medicina Interna

On-line version ISSN 2312-3893


CODAS, Manuel et al. Cyclical attacks of hypertension and hypotension in a young adult. Rev. virtual Soc. Parag. Med. Int. [online]. 2018, vol.5, n.1, pp.78-82.  Epub Mar 01, 2018. ISSN 2312-3893.

We present a clinical case of a 35-year-old male patient, known hypertensive for one year, without treatment. Two hours before admission, after a moderate effort, he presented oppressive precordial pain radiating to the left arm, followed by progressive weakness of the left side of the body until paresis, so he goes to Emergency. He is hemodynamically unstable at admission with AP 210/100 mmHg, pulse 110/min, eupneic. Labetalol EV 20 mg was started with good response (AP 130/70mmHg) until its control of 80/40mmHg at 20 min. With pale facies, cold sweating, paresis of left hemibody with force III/V, sensibility abolished in left leg and left Babinski. In the initial analysis, it presents normal biochemical markers, including urinalysis and arterial blood gas analysis. The simple tomography of the skull does not reveal obvious alterations. After the cessation of neurological symptoms, the blood pressure rises to 280/180 mmHg, which is why labetalol is started in continuous infusion at 2 mg / min, with a good response. Normal Doppler ultrasound of renal vessels. Increased levels of metanephrines in urine and blood and urinary vanillylmandelic acid of 24 hours are observed. The contrast tomography of the abdomen shows an adrenal tumor. Patient moves to a hospital in the city of Posadas, Argentina for surgical intervention with prior preparation using α-blockers.

Keywords : pheochromocytoma; catecholamines; hypertension; chest pain.

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