To the Editor.—
As a heavy coffee drinker, I was reassured by the article by Heyden et al in the October Archives (138:1472-1475, 1978) demonstrating that mortality from all causes was not higher in people who consume large amounts of coffee. However, one of my patients with an unusual coffee intake did seem to suffer important symptoms because of coffee consumption.
Report of a Case.—
A 24-year-old man came for evaluation of persistent nervousness, tachycardia, sweating, headaches, and chest discomfort. The patient had undergone a left adrenalectomy two years before for "pheochromocytoma." Despite the operation, his symptoms persisted. Coronary artery catheterization was normal. Review of the hospital record revealed that prior to the operation, the urine vanillylmandelic acid (VMA) level was 13 mg/24 hr (normal, 0 to 12 mg/24 hr) and the urine catecholamine level was 305 μg/24 hr (normal, 15 to 140 μg/24 hr). The blood pressure during his