<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932018000100078</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2018.05(01)78-082</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Ataques cíclicos de hipertensión e hipotensión en un adulto joven]]></article-title>
<article-title xml:lang="en"><![CDATA[Cyclical attacks of hypertension and hypotension in a young adult]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Codas]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Haurón]]></surname>
<given-names><![CDATA[Guido]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Achucarro]]></surname>
<given-names><![CDATA[David]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Usher]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pescador Ruschel]]></surname>
<given-names><![CDATA[Marco Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sebriano]]></surname>
<given-names><![CDATA[Marcelo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bóveda]]></surname>
<given-names><![CDATA[Luz]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Itapúa. Servicio de Clínica Médica del Hospital Regional de Encarnación ]]></institution>
<addr-line><![CDATA[Encarnación ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Nacional de Itapúa Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Encarnación ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2018</year>
</pub-date>
<volume>5</volume>
<numero>1</numero>
<fpage>78</fpage>
<lpage>82</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932018000100078&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932018000100078&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932018000100078&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Se presenta caso clínico de paciente varón de 35 años, conocido hipertenso hace 1 año, sin tratamiento. Dos horas antes del ingreso, después de un esfuerzo moderado, presenta dolor precordial opresivo que se irradia a brazo izquierdo, seguido de debilidad progresiva de hemicuerpo izquierdo hasta la paresia, por lo que acude a Urgencias. A la admisión se encuentra hemodinámicamente inestable por PA 210/100 mmHg, pulso 110/min, eupneico. Se inicia labetalol EV 20 mg con buena respuesta (PA 130/70mmHg) hasta su control de 80/40mmHg a los 20 min. Con facies pálida, sudoración fría, paresia de hemicuerpo izquierdo con fuerza III/V, sensibilidad abolida en pierna izquierda y Babinski izquierdo. En la analítica inicial presenta marcadores bioquímicos normales, incluyendo el urianálisis y la gasometría arterial. La tomografía simple de cráneo no revela alteraciones evidentes. Después del cese de los síntomas neurológicos la presión arterial asciende a 280/180 mmHg, por lo que se inicia labetalol en infusión contínua a 2 mg/min, con buena respuesta. Ecografía Doppler de vasos renales normal. Se constata niveles aumentados de metanefrinas en orina y sangre y ácido vanililmandélico urinario de 24 hs. A la tomografía contrastada de abdomen se constata tumoración adrenal. Paciente se traslada a Hospital en la ciudad de Posadas, Argentina para intervención quirúrgica con previa preparación con &#945;-bloqueantes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT 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 &#945;-blockers.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[feocromocitoma]]></kwd>
<kwd lng="es"><![CDATA[catecolaminas]]></kwd>
<kwd lng="es"><![CDATA[hipertensión]]></kwd>
<kwd lng="es"><![CDATA[dolor en el pecho]]></kwd>
<kwd lng="en"><![CDATA[pheochromocytoma]]></kwd>
<kwd lng="en"><![CDATA[catecholamines]]></kwd>
<kwd lng="en"><![CDATA[hypertension]]></kwd>
<kwd lng="en"><![CDATA[chest pain]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Manger]]></surname>
<given-names><![CDATA[WM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and management of pheochromocytomas-recent advances and current concepts.]]></article-title>
<source><![CDATA[Kidney Int.]]></source>
<year>2006</year>
<volume>70</volume>
<numero>^sSuppl 104</numero>
<issue>^sSuppl 104</issue>
<supplement>Suppl 104</supplement>
<page-range>S30-5</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lenders]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Eisenhofer]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Mannelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pacak]]></surname>
<given-names><![CDATA[K.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Phaeochromocytoma]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2005</year>
<volume>366</volume>
<numero>9486</numero>
<issue>9486</issue>
<page-range>665-75</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mittendorf]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Evans]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Perrier]]></surname>
<given-names><![CDATA[ND.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pheochromocytoma]]></article-title>
<source><![CDATA[Hematol Oncol Clin North Am]]></source>
<year>2007</year>
<volume>21</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>509-25</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pacak]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Eisenhofer]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ahlman]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Bornstein]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Gimenez-Roqueplo]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Grossman]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pheochromocytoma]]></article-title>
<source><![CDATA[Nat Clin Pract Endocrinol Metab.]]></source>
<year>2005</year>
<volume>3</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>92-102</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shamsuddin]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[W.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A Case report of a Pheochromocytoma presenting with neurological manifestations.]]></article-title>
<source><![CDATA[The Medicine Forum.]]></source>
<year>2009</year>
<volume>11</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>48-9</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kernan]]></surname>
<given-names><![CDATA[WN]]></given-names>
</name>
<name>
<surname><![CDATA[Ovbiagele]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Black]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Bravata]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Chimowitz]]></surname>
<given-names><![CDATA[MI]]></given-names>
</name>
<name>
<surname><![CDATA[Ezekowitz]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack]]></article-title>
<source><![CDATA[Stroke]]></source>
<year>2014</year>
<volume>45</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>2160-236</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lenders]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Pacak]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Walther]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Linehan]]></surname>
<given-names><![CDATA[WM]]></given-names>
</name>
<name>
<surname><![CDATA[Mannelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Friberg]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biochemical diagnosis of pheochromocytoma]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2002</year>
<volume>287</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1427-34</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Luster]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Karges]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Zeich]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Pauls]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Verburg]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Dralle]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical value of (18) F-fluorodihydroxyphenylalanine positron emission tomography/computed tomography (18F-DOPA PET/CT) for detecting pheochromocytoma.]]></article-title>
<source><![CDATA[Eur J Nucl Med Mol Imaging]]></source>
<year>2010</year>
<volume>37</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>484-93</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ilias]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Pacak]]></surname>
<given-names><![CDATA[K.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis, localization and treatment of pheochromocytoma in MEN 2 syndrome.]]></article-title>
<source><![CDATA[Endocr Regul]]></source>
<year>2009</year>
<volume>43</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>89-93</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leung]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Stamm]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Raja]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Low]]></surname>
<given-names><![CDATA[G.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pheochromocytoma]]></article-title>
<source><![CDATA[AJR Am J Roentgenol]]></source>
<year>2013</year>
<volume>200</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>370-8</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Al-Salamah]]></surname>
<given-names><![CDATA[SM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgery for pheochromocytoma]]></article-title>
<source><![CDATA[Ann Saudi Med]]></source>
<year>2002</year>
<volume>22</volume>
<numero>5-6</numero>
<issue>5-6</issue>
<page-range>392-5</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
