To the Editor.
—I am grateful to Gotshall for his recent emphais on autonomic hyperreflexia in spinal cord injury.1 I have been pondering the cause of a patient's sudden hypertension and autonomic hyperreflexia may have been the mechanism.A 40-year-old woman with widespread osseous metastases from cancer of the breast underwent bilateral adrenalectomy without complications after an 18 month remission induced by oophorectomy. Blood pressures before, during, and immediately after the operation ranged from 90/60 to 150/100 mm Hg. On the first three postoperative days numerous blood pressure determinations varied from 150/80 to 180/110 mm Hg. On the fourth postoperative day blood pressures of 154/94 and 150/94 mm Hg were recorded in the morning. After a pelvic examination, done for investigation of a profuse vaginal discharge, blood pressures of 200/90 and 200/105 mm Hg were recorded within the hour. Blood pressure fluctuations from 130/80 to 180/110 mm Hg were