A visual diagnosis of phaeochromocytoma crisis characterised by cyclic fluctuations of blood pressure: be on the look-out for rapid changes

On examination he was unwell and distressed; he had cold and clammy skin, and marked hypertension with a blood pressure of 250/140 mm Hg and pulse rate of 88 beats per min and oxygen saturation of 95%. Invasive monitoring of the patient's blood pressure and heart rhythm—using a peripheral catheter in the radial artery—showed severe cyclic variation with reciprocal changes of the heart rate at intervals of 15 min: with systolic pressure ranging between 45 mm Hg and 310 mm Hg; diastolic pressure ranging between 35 mm Hg and 160 mm Hg; and the heart rate fluctuating between 70 beats per min and 130 beats per min (figure 1; appendix). The patient was allowed home 21 days after admission; at follow-up 3 months later, he was well and ambulatory blood pressure monitoring showed an average of 119/76 mm Hg (average daytime reading was 124/83 mm Hg and night-time 108/63 mm Hg) while prescribed ramipril 5 mg once a day and amlodipine 5 mg once a day.