| Simulation of a pheochromocytoma--Munchausen syndrome. | |
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MedLine Citation:
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PMID: 9889174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A 46-year old female nursing sister was admitted to three different hospitals because of blood pressure crises of 300/150 mmHg which occurred up to six times a day. The rises in blood pressure were accompanied by headache, tachycardia and outbreaks of sweating. Raised catecholamine concentrations were repeatedly measured in the 24-hour urine and in the blood. The diagnosis of pheochromocytoma could therefore be regarded as confirmed. The investigations to establish the localization (including MIBG scintigrams carried out several times) showed negative results. Octreotide scintigraphy finally revealed a raised concentration of nuclides in the right adrenals. Selective venous blood samples showed markedly raised concentrations of adrenaline and noradrenaline in all regions investigated. After removing the right adrenal, which was of normal histological appearance, there was an improvement for six months. Afterwards, up to six blood pressure crises per day were observed once more. Fresh determination of catecholamines at various levels demonstrated the highest concentrations in the left iliac vein. It was then shown that the patient injected catecholamines intravaginally even during the angiographic investigation. A search of the patient s room revealed several ampoules containing noradrenaline and adrenaline as well as syringes and needles. - This case shows that in clinical pictures with typical clinical symptoms and negative results of repeated investigations a factitious disorder must be considered in terms of differential diagnosis especially when female patients with medical knowledge who have ready access to drugs are involved with a history comprising several stays in hospital which have not produced any clarification of their condition. |
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Authors:
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D Spitzer; D Bongartz; T H Ittel; H G Sieberth |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: European journal of medical research Volume: 3 ISSN: 0949-2321 ISO Abbreviation: Eur. J. Med. Res. Publication Date: 1998 Dec |
Date Detail:
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Created Date: 1999-02-16 Completed Date: 1999-02-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9517857 Medline TA: Eur J Med Res Country: GERMANY |
Other Details:
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Languages: eng Pagination: 549-53 Citation Subset: IM |
Affiliation:
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Medizinische Klinik II, Universitätsklinikum der RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. spitzer@silmaril.imib. rwth-aachen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Gland Neoplasms
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blood,
diagnosis*,
physiopathology Diagnosis, Differential Epinephrine / administration & dosage, blood Female Humans Hypertension / physiopathology Middle Aged Munchausen Syndrome / blood, diagnosis*, physiopathology Norepinephrine / administration & dosage, blood Pheochromocytoma / blood, diagnosis*, physiopathology Self Medication |
| Chemical | |
Reg. No./Substance:
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51-41-2/Norepinephrine; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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