Fluctuating blood pressure

[anj_2007]

I am a 19 year old female in good health (at least, aside from these symptoms) . I do not smoke, I drink in moderation occasionally, and I eat well.  For the past few months, my doctor had noticed my blood pressure seemed to be slightly elevated during my visits (about 130/95 each time). I attributed the slight elevation to stress because the readings had seemed to be on days where I was more stressed out than normal, such as an exam day. However, about two weeks ago I was driving to class and suddenly had the feeling of being very hot and very dizzy. Walking to and from each of my classes was almost unbearable and I began to feel very weak, as if I could pass out at any minute. After classes were over, I had my blood pressure taken by my mother and found that it was around 170/110. I was unable to get a doctors appointment until the following week. My blood pressure was taken 2-3 times a day with reading no lower than 145/105 for the next two days. After three consecutive days of maintianing a very high blood pressure, even after cutting almost all salt from my diet, I went to the ER. I spent the night in the hospital, and was given numerous blood and urine tests, as well as a CAT scan of my head. My blood pressure was taken every 10 minutes throughout the night and became as high as 187/130. After finding no other abnormalities, I was sent home and given a presciption for hydrochlorothiazide, a water pill. I continued to monitor my blood pressure several times a day only to find that not only had it stayed just as high most of the time, but it would also dip extremely low about once a day (when it was taken 3-4 times a day), to about 80/0, the second number being unable to be read, even after several attempts by my mom, who is a doctor. After about two days out of the hospital, my family doctor prescribed me Norvasc over the phone. However, some days I can not take it because my blood pressure was so low to begin with. The Norvasc does not seem to help with the high blood pressure significantly, even after I take it my blood pressure will still rise to about 150/100. My blood pressure also does not seem to be salt sensitive, as it will be high on days I avoid salt and low on days that I eat salty foods. My doctor has ordered me to take a 24-hour urine analysis to test for adrenal tumors, as well as a ultrasound to test to ensure the veins surrounding my kidneys are working properly. If both tests find nothing, I will be referred to a heart specialist. I am concerned about arenal tumors because I have had recent problems with anxiety and I know that is a major red flag. Are there any other symptoms that are associated with adrenal tumors? and if I am diagnosed with an adrenal tumor, what will that mean? If the tests com back negative and I am sent to a heart specialist, what will be a likely diagnosis? Any information on this will be greatly appriciated.

[Bhupinder Kaur, MD]

Hello,

What the doctor means to check is for phreochromocytoma. Pheochromocytoma is a neoplasm of the adrenal medulla. Only 10% of adrenal pheochromocytomas are malignant, while the rest are benign tumors.They may lead to potentially life-threatening high blood pressure, or cardiac arrythmias, and numerous symptoms such as headache, palpitations, anxiety attacks, sweating, weight loss, and tremor.

Diagnosis is most easily confirmed through urinary measurement of catecholamine metabolites such as VMA and metanephrines. Most pheochromocytomas are initially treated with anti-adrenergic drugs and then surgery to remove the tumor once the BP is stable.

Take care and pls do keep me posted on how you are doing or if you have any additional doubts.

[anj_2007]

Thanks for the web site. I honestly dont know how high my heart rate is. I haven't been told by any doctors to keep an eye on it. I know that my cholesterol is normal though, and I am a healthy weight. My doctor seemed more concerned about how my blood pressure varies from being so high to very low often. I do have a family history of high blood pressure, but because of my age and the variation of it I was told that it is most likely being caused by something else.  How long has your husband had high blood pressure? Has he had extremely low blood pressure at times?

[Encephalomalcia]

Here is a website with information on the adrenal tumor: http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/Endocrine%20tumors/adrenal/adrenal%20tumors.html

Is your heart rate also high?  Something must be going on because high blood pressure is a symptom.  My husband takes hydrochlorothiazide and it works for him.  Is your cholesterol high?