PHEOCHROMOCYTOMA AND ESSENTIAL HYPERTENSIVE VASCULAR DISEASE

THAT essential hypertensive vascular disease may be clinically indistinguishable from the syndrome presented by certain patients with pheochromocytoma has been frequently and properly emphasized in recent years.¹ The pharmacologic actions of epinephrine, the only pressor agent which had been demonstrated in these neoplasms, could account for the so-called adrenal-sympathetic syndrome associated with paroxysmal hypertension but were hard to reconcile with a hemodynamic picture resembling essential hypertensive vascular disease. When epinephrine is infused into a normal man at a rate sufficient to produce a systolic blood pressure of 180 mm. Hg, there is usually no significant elevation of diastolic pressure, and the infusion is accompanied with a number of unpleasant symptoms, such as anxiety and palpitation; further increase in the rate of epinephrine administration is often marked by the appearance of extrasystoles, restlessness and hyperpnea. Another striking variance from the picture of essential hypertensive vascular disease is the fact that