I M signs. The chest was clear to auscultation, and heart sounds were normal without murmurs. The abdomen was plain and not tender, without masses or organomegalies.Results of urinalysis, complete blood count, serum electrolyte levels, hepatic-function and renal-function tests showed no abnormalities.A 24-h ambulatory blood pressure monitoring was then performed (Spacelabs 90207-30, with recording of blood pressure every 15 min), revealing a normotensive state throughout the registration (24 h mean blood pressure: 125±12/68±8 mmHg; preserved nocturnal blood pressure fall). An echocardiogram revealed normal parietal thickness and function and a radiograph of the chest showed no abnormalities.
Discussion for differential diagnosisProf. Luigina Guasti, Prof. Anna Maria Grandi, Dr. Cinzia Simoni, Dr. Mariagrazia Cimpanelli, Dr. Chiara Crespi: The patient's history was suggestive of secondary forms of hypertension, so we performed the following examinations, with results within the normal range: urinary catecholamines and vanillymandelic acid, 24-h urine-free cortisol, plasma renin activity and aldosterone with their ratio, plasma thyroid hormones. As the results were within the normal ranges, and the clinical presentation was particularly consistent with a preliminary diagnosis of pheochromocytomas, we repeated the urine collection for catecholamines, with normal results. Moreover, we evaluated plasma 5-hydroxyindoleacetic acid in the hypothesis of the presence of a carcinoid tumour. In addition, plasma IGF-1 was determined to exclude excessive GH production.One month later, the patient experienced one episode of loss of consciousness, immediately after getting out of bed during the night, with a consequent fall and fracture of her wrist. The blood pressure measured immediately after the Intern Emerg Med (2007)
Presentation and historyProf. Achille Venco, Prof. Luigina Guasti: A 67-year-old woman was seen at our hospital for an outpatient evaluation. She had a recent history of hypertensive crises (mean blood pressure peaks of 230/120 mmHg). She also complained of several symptoms associated with the hypertensive spells, such as fatigue, malaise, irritability, profuse sweating, tremulousness, dyspnoea and abdominal pain, all of them lasting about one hour and with a spontaneous recovery.She was married, and had no medical history. She did not smoke or consume alcohol. She was not taking any medication and had no allergies.On examination, blood pressure and heart rate were normal (120/70 mmHg; 64 beats/min), as were the other vital
