Surreptitious Self-administration of Epinephrine Resulting in 'Pheochromocytoma'

SELECTED CASE A 35-YEAR-OLD woman with a possible pheochromocytoma was referred to the National Institutes of Health (NIH) from Pittsburgh, Pa. Her symptoms started in December 1987, when she developed headache, tremor, tachycardia, and mild hypertension after an injection of novocaine and epinephrine. Soon the episodes began to occur spontaneously. She often went to a local emergency department, where her blood pressure was as high as 160/100 mm Hg and her heart rate as high as 140 beats per minute. Her urinary epinephrine output was 1600 nmol/d (normal, <165 nmol/d). Her plasma norepinephrine (NE) level was 2.9 nmol/L (normal, <4.4 nmol/L) and plasma epinephrine, 2.8 nmol/L (normal, <0.55 nmol/L). In February 1988, a clonidine suppression test was performed. Basal plasma NE level was normal (1.4 nmol/L) and was suppressed normally to 0.49 nmol/L; basal plasma epinephrine level was markedly elevated (1.8 nmol/L), and was also suppressed into the normal range