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Obstructive Sleep Apnea Presenting as Pseudopheochromocytoma: A Case Report

Departments of Endocrinology (L.J.H., M.E., S.L.C., J.P.M., K.A.M.) and Respiratory Medicine (J.A.W.), St. Bartholomew’s Hospital, London, United Kingdom EC1A 7BE; and Department of Medicine, Southend General Hospital (L.J.H., A.G.D., K.A.M.), Westcliff-on-Sea, United Kingdom SSO 0RY

Address all correspondence and requests for reprints to: Dr. K. A. Metcalfe, Department of Endocrinology, Southend General Hospital, Prittlewell Chase, Westcliff-on-Sea, United Kingdom SSO 0RY. E-mail: karl.metcalfe{at}southend.nhs.uk.

Sudden arousal from sleep causes a transient surge in sympathetic nervous activity. Repeated arousals, as occur in obstructive sleep apnea (OSA), are well documented to cause a more prolonged sympathetic overactivity and consequent elevations in 24-h urinary catecholamine levels. We describe here a series of five patients, each presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. Thorough investigations have failed to find catecholamine-secreting tumor in any of these subjects, but all have been diagnosed with OSA. Primary treatment of OSA with nasal continuous positive airways pressure has led to normalization of systemic blood pressure and urinary catecholamines. Pseudopheochromocytoma is therefore a rare, but treatable, presentation of obstructive sleep apnea.

Abbreviations: AHI, Apnea/hypopnea index; CPAP, continuous positive airways pressure; CT, computed tomography; MIBG, metaiodobenzylguanidine; OSA, obstructive sleep apnea.

¹ Data from cases 2 and 3 have been published elsewhere as follows: Obstructive Sleep Apnoea and Pseudophaechromocytoma, Case Presentation at the Society for Endocrinology Clinical Practice Day, University of Reading, Reading, UK, July 12, 2002; and Obstructive Sleep Apnoea: A Cause of Pseudophaeochromocytoma, poster at the 193rd Society for Endocrinology Annual Meeting and Joint Meeting with Diabetes UK, London, UK, November 4–6 2002. The above is also published by the Society for Endocrinology as an abstract in Endocr Abstr 4:14–15, 2002.