A patient with severe hypertension, anxiety, and palpitations has elevated urinary catecholamines. What is the diagnosis?

• A. Pheochromocytoma
• B. Hyperthyroidism
• C. Panic attack
• D. Hypertensive emergency

Answer: (A)

Excess catecholamine production from a tumor of chromaffin cells in the adrenal medulla (pheochromocytoma) explains both the elevated urinary catecholamines and the sympathetic symptoms of hypertension, anxiety, and palpitations. Pheochromocytoma releases large amounts of epinephrine and norepinephrine, causing episodic or sustained high blood pressure along with tachycardia, anxiety, sweating, and palpitations. The finding of high urinary catecholamines (or metanephrines) is a classic clue pointing to this diagnosis.

Hyperthyroidism can cause tachycardia and anxiety but typically doesn’t elevate urinary catecholamines. Panic attacks can mimic the symptoms, but catecholamine levels in urine aren’t consistently elevated. Hypertensive emergency describes a dangerous BP state, not a specific underlying source of catecholamines. Therefore, pheochromocytoma best accounts for the combination of symptoms and the lab finding.