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Mental Health (Expert Forum)
anxiety vs. pheochromocytoma
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
anxiety vs. pheochromocytoma
by pandora9048, Oct 21, 2003 12:00AM
hi,
im a 30-year-old female. my problems started in June of this year. I woke up suddenly in the middle of the night with a racing heartbeat, feeling like i couldn't breathe, hot flashes followed by chills and trembling. since that day, i have been experiencing almost daily episodes of sinus tachycardia. i also feel flushed if my heart reaches over 100 bpm. I haven't felt right since that day. i've had an echocardiogram, event monitor for 21 days, several ekg's, blood work, and a chest xray. these have all been "normal," although the sinus tach did show on the event monitor. my cardiologist doesn't seem to think this is a cardiac problem (this does nothing to calm me down). at this point he wants me to have a 24-hour urine test to check for extra adrenaline. I wasn't too concerned about this until I looked on the Internet what this test was for (pheochromocytoma, carcinoid syndrome). The thought of going for this test is causing me heart palpitations in and of itself, although i know i should. I have a family history of anxiety and also have been taking Xanax .5 mg twice a day since that June episode. in the morning when i get up i feel very jittery, nervous, like im jumping out of my skin. this usually feels less intense after i take the xanax.
I have three questions:
1) in the absence of high blood pressure, can pheochromocytoma still be the cause of my tachycardia?
2) although the Xanax worked well when I first started taking them, I feel that they are less effective now. could the jitter feeling i have in the morning be because I have become used to them and it's kind of like a withdrawal symptom?
3) i would like to stop taking the Xanax every day. how is the best way to stop??
Please help me. it's gotten to the point where I'm convinced im dying. i feel my pulse constantly, am constantly worried about my heart and i dont even want to go to work anymore (which unfortunately I have to do as I have three children.
im a 30-year-old female. my problems started in June of this year. I woke up suddenly in the middle of the night with a racing heartbeat, feeling like i couldn't breathe, hot flashes followed by chills and trembling. since that day, i have been experiencing almost daily episodes of sinus tachycardia. i also feel flushed if my heart reaches over 100 bpm. I haven't felt right since that day. i've had an echocardiogram, event monitor for 21 days, several ekg's, blood work, and a chest xray. these have all been "normal," although the sinus tach did show on the event monitor. my cardiologist doesn't seem to think this is a cardiac problem (this does nothing to calm me down). at this point he wants me to have a 24-hour urine test to check for extra adrenaline. I wasn't too concerned about this until I looked on the Internet what this test was for (pheochromocytoma, carcinoid syndrome). The thought of going for this test is causing me heart palpitations in and of itself, although i know i should. I have a family history of anxiety and also have been taking Xanax .5 mg twice a day since that June episode. in the morning when i get up i feel very jittery, nervous, like im jumping out of my skin. this usually feels less intense after i take the xanax.
I have three questions:
1) in the absence of high blood pressure, can pheochromocytoma still be the cause of my tachycardia?
2) although the Xanax worked well when I first started taking them, I feel that they are less effective now. could the jitter feeling i have in the morning be because I have become used to them and it's kind of like a withdrawal symptom?
3) i would like to stop taking the Xanax every day. how is the best way to stop??
Please help me. it's gotten to the point where I'm convinced im dying. i feel my pulse constantly, am constantly worried about my heart and i dont even want to go to work anymore (which unfortunately I have to do as I have three children.
Doctor's Answer
by Roger Gould, M.D., Oct 22, 2003 12:00AM
, Oct 22, 2003 12:00AM
The most likely diagnosis is anxiety attacks, and this is just the way they start and play themselves out. The best treatment is a combination of medications and psychotherapy...much better than either alone.
Re medications, you might want to stop Xanax and switch to a longer term medication like Klonopin. Stopping Xanax is tricky...should do it slowly over 3 week period to avoid seizures and withdrawal symptoms. There are other anxiolytic medications so you should see a psychopharmacologist.
Pheochromocytoma is a rare but important thing to rule out. Yes you can have it without blood pressure increase but it is not common.
Re medications, you might want to stop Xanax and switch to a longer term medication like Klonopin. Stopping Xanax is tricky...should do it slowly over 3 week period to avoid seizures and withdrawal symptoms. There are other anxiolytic medications so you should see a psychopharmacologist.
Pheochromocytoma is a rare but important thing to rule out. Yes you can have it without blood pressure increase but it is not common.
