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anxiety vs. pheochromocytoma

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.
1 Responses
242532 tn?1269553979
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.
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