SUMMARY To assess factors in overweight persons that account for a tendency toward hypertension, 33 very obese women, 26 to 77 years of age, were studied. Blood pressures in these 33 women varied from low normal to mildly hypertensive. None of them had taken medication for high blood pressure, and none had diabetes mellitus. The effect of independent variables -age, body mass index (weight/height 2 ), fasting serum glucose levels, fasting serum insulin levels, and 24-hour urinary sodium excretion -on systolic and diastolic blood pressure was assessed. There was no correlation between sodium excretion and blood pressure. Age did not correlate with diastolic blood pressure but did correlate with systolic blood pressure when body mass index, serum glucose level, and insulin level were controlled. Diastolic blood pressure correlated with body mass index and serum glucose level, but only the latter remained significant when all independent variables were considered together. Both systolic and diastolic blood pressure were found to be significantly related to fasting serum insulin level (r = 0.47, p = 0.005 and r = 0.68, p < 0.001) even when age, weight, and serum glucose level were controlled (r = 0.41, p = 0.025 and r = 0.62, p < 0.001 respectively). The relation between serum insulin and blood pressure was more pronounced in those women with a family history of hypertension. These data indicate that insulin may play a major role in the regulation of blood pressure in obesity and that the previously accepted relation of weight to blood pressure may depend on blood levels of insulin. (Hypertension 7: 702-706, 1985) KEY WORDS • obesity • blood pressure • insulin • sodium excretion O BESITY is often associated with elevated blood pressure.1 ' 2 One of the factors thought to be responsible for this tendency toward hypertension is the often-observed hyperinsulinemia of obese subjects. 3•* This viewpoint is bolstered by observations that short-term insulin administration to normal subjects results in sodium retention, 5 -6 as well as increased blood pressure and heart rate. The present study examines the relation of age, weight, sodium intake, serum glucose level, and serum insulin level to blood pressure in markedly obese subjects. The results from this cross-sectional analysis indicate that obese persons with higher blood pressure tend to have the highest serum insulin levels and that this association is independent of age, weight, and serum glucose level.Subjects and Methods Thirty-three obese women, ranging in age from 26 to 77 years, who were at least 33% above calculated ideal weight, were studied in the Wayne State Univer-

A 66-year-old woman presented 21 years prior with diarrhea and elevated serum calcitonin levels. The left lobe of the thyroid was aspirated but specimen was unsatisfactory. Nevertheless, based on the radiological and clinical impressions, the patient underwent total thyroidectomy and the histologic examination established the diagnosis of medullary thyroid carcinoma (MTC). Approximately 5 years later, the patient had a recurrence of the disease and underwent a neck lymph node dissection, which showed metastatic MTC in a lymph node. Sixteen years later, the patient presented with left neck mass detected by ultrasound in the area of thyroid bed. Fine needle aspiration (FNA) of this area was performed and the FNA diagnosis was consistent with oncocytic variant of MTC. This case illustrates a first report of this uncommon variant of MTC diagnosed by FNA cytology of the thyroid bed.

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These three cases show that the laboratory diagnosis of pheochromocytoma, like that of other endocrine disorders, may be in error if the physiologic state of the patient is not taken into consideration. Each of these patients had a condition that enhanced catecholamine production--hypothyroidism in one case, volume depletion induced by use of diuretics in another, and alcoholism in the third. When these conditions were controlled, catecholamine values returned to normal.

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