Nausea, vomiting, and panic attacks in a 50-year-old woman

CASE CONCLUSION AND FOLLOW-UP

Two months after her initial presentation, the patient underwent open surgery and had the mass removed without complications. She reports that the “panic attacks” have ceased completely.

The recurrence rate of pheochromocytoma is 13% in patients with sporadic disease and 33% in patients with familial syndromes. The overall recurrence rate with long-term follow-up is 17%, half of recurrences being malignant disease. All patients should therefore be followed in the clinic annually for at least 10 years to identify and treat recurrences early,⁷ and many experts recommend lifelong follow-up, even for patients without hereditary syndromes.¹⁷

Nearly every diagnosis in the DSM-IV includes the caveat that medical causes of disease must be excluded before psychiatric labels can be applied. Although panic disorder and panic attack are far more common than pheochromocytoma, just as essential hypertension is far more common than pheochromocytoma, physicians need to remember that pheochromocytoma can cause symptoms common to both illnesses. Thus, while rare conditions are rare, atypical presentations of common conditions may deserve a second glance.