Labile hypertension, headaches and tremors

[riverdaze]

I'm having dizzy spells (don't think it's vertigo), labile hypertension, daily headaches and occasional fine tremors for a month now.
Dr has put me on antihypertensives 2 weeks ago for BP (my final diagnosis is severe hypertension).   By the way, I had these symptoms before starting the meds.

Not sure what to do or where to go from here really as getting fed up with the problem - unable to work at the moment either.

[LivingInHope]

That's plasma free metanephrines- it is a fasting blood test and you shouldn't take any tylenol (check with your doctor about other meds to be avoided) prior to the test.  You will want to get it done while you have been recently having an episode of severe hypertension.  I have read online that pheochromocytomas can have silent periods, where they are not emitting catecholamines at high levels.  Also, I believe they use a purple topped tube and need to put it on ice right away after collecting your sample.   See PM for more info.

[riverdaze]

The VMA test was to check for a pheo and if I can get the plas metanephrine test that (apparently) is more accurate than the VMA.  Still waiting to follow this up.

[rumpled]

Has anyone thought of Pheochromocytoma? That would cause severe hypertension.

[riverdaze]

No, I haven't had a bran scan.  

When I had my main dizzy spell crisis I was working as an RN in the ED.  I was put on a monitor and my BP was very labile (60/40 - 235/149) as was my heart rate, ranging from 39 - 160. (My normal resting heart rate is anywhere between 47 - 65).

I saw a cardiologist privately (diagnosed severe HTn, mild mitral regurg and 2 x flow murmurs plus LVH) and also had the VMA urine test (neg).  I asked my GP to arrange the plasma metanephrine test but the path lab is making a fuss stating that the urine test is sufficient. (Didn't know that had to be a fasting test).  I do have many of the symptoms of a pheo (having researched it) but it seems it's a really difficult diagnoses to reach.

I did have ?orthostatic hypotension (and postural HTN) as an ED diagnosis but as I had been having chest pain, etc, they decided to let me go down the cardiology route first.....I seem to have come to a dead end now!  I'm now on perindopril for the HTN.  

I feel that I should have a head CT but I need to convince the doctors of this!  As for an EEG, I don't think that would enter the discusion at this point.

(I did put the same post with more info on a different section - I'm new to this site so sorry if I have repeated myself somewhere).

[LivingInHope]

Hopefully, you have had a brain scan, including a look at the blood vessels?   What about an EEG?   Is there any spike in blood pressure when you are standing versus lying down or sitting, or is your blood pressure high regardless of your position?  (I ask as in the hyperadrenergic form of POTS or postural orthostatic tachycardia syndrome, spikes in BP happen with standing.)

And with labile hypertension and headaches, please get a fasting plasma free metanephrines test to rule out a serious but rare catecholamine emitting pheochromocytoma that can cause those symptoms.  I hope the doctor put you on something like labetolol until he/she ruled out that kind of tumor.  Plasma free metanephrines is considered the most sensitive for ruling out pheochromocytoma.