If not pheo, what do I have?

Pheo is a rare disease. In my practice, I see many patients who are suspected by their doctors of having pheo. After evaluating the patients, I generally find that only about 10% of them really have pheo, but the other 90% do not. The patients' response is usually predictable. Those who are diagnosed by me to have pheo are happy (and apprehensive, of course) after I discuss the nature of the disease and treatment plan. Those who do not have pheo are disappointed and frustrated. From the patients' point of view, they don’t care too much whether they have pheo or not per se, but they do want to feel better. If it is not pheo, what else is wrong?

About half of the patients for whom pheo is ruled out, especially young patients with hypertension, just have “essential hypertension”. Essential hypertension is a vague diagnosis simply meaning that the doctors don’t know why the patients have hypertension. Most patients with essential hypertension have a family history of hypertension. Their hypertension has multiple causes but none of the causes stands out obviously.

About a quarter of patients have obstructive sleep apnea (OSA). Patients with OSA are in a chronic stress mode so that they have catecholamine surges. OSA is pretty common and affects 5-10% of all people. Many people do not know they have OSA. The doctor has to probe whether the patient snores or has daytime somnolence. If the patient has suggestive symptoms, a consultation from a sleep specialist or pulmonologist is very valuable. The effects of CPAP treatment can be dramatic.

Another quarter of patients have anxiety disorder. People tend to have negative emotional reactions toward anxiety disorder. Some would wonder why they have the disease if they are not really anxious about anything. Anxiety disorder is a disease that we don’t know the cause of, just as depression is a disease that we don’t know the cause of. Patients should be evaluated by a psychiatrist to make the anxiety disorder diagnosis and to provide treatment.

There are nearly 30 other diseases that can also mimic pheo. These are generally much rarer and I do not see them often. Finally, I want to emphasize that the above is based on my personal experience; other doctors may have a different view.

Dr. Pheo