January 2020 By PsychDB.com

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anxiety:panic [January 2020]
PsychDB.com [Diagnostic Criteria]
anxiety:panic [January 2020] (current)
PsychDB.com [Differential Diagnosis]
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   * Pheochromocytoma,​ rarely, this should be considered on the differential. Especially if the patient is not responding to conventional treatments[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC5890079/​|Alguire,​ C., Chbat, J., Forest, I., Godbout, A., & Bourdeau, I. (2018). Unusual presentation of pheochromocytoma:​ thirteen years of anxiety requiring psychiatric treatment. Endocrinology,​ diabetes & metabolism case reports, 2018.]])][([[https://​www.endocrine-abstracts.org/​ea/​0032/​ea0032p569|Muroya,​ Y., Kumagai, N., Shimodaira, M., Tsuzawa, K., Sorimachi, E., Arioka, H., & Honda, K. (2013, April). A case of pheochromocytoma that recognized as panic disorder before its exact diagnosis. In 15th European Congress of Endocrinology (Vol. 32). BioScientifica.]])]   * Pheochromocytoma,​ rarely, this should be considered on the differential. Especially if the patient is not responding to conventional treatments[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC5890079/​|Alguire,​ C., Chbat, J., Forest, I., Godbout, A., & Bourdeau, I. (2018). Unusual presentation of pheochromocytoma:​ thirteen years of anxiety requiring psychiatric treatment. Endocrinology,​ diabetes & metabolism case reports, 2018.]])][([[https://​www.endocrine-abstracts.org/​ea/​0032/​ea0032p569|Muroya,​ Y., Kumagai, N., Shimodaira, M., Tsuzawa, K., Sorimachi, E., Arioka, H., & Honda, K. (2013, April). A case of pheochromocytoma that recognized as panic disorder before its exact diagnosis. In 15th European Congress of Endocrinology (Vol. 32). BioScientifica.]])]
     *  The classic triad of pheochromocytoma symptoms includes headache, excessive sweating, and palpitations. Around 15%-20% of patients with a pheochromocytoma patients may be normotensive.     *  The classic triad of pheochromocytoma symptoms includes headache, excessive sweating, and palpitations. Around 15%-20% of patients with a pheochromocytoma patients may be normotensive.
-    * Testing for plasma ​metanephrines (95% sensitivity) ​and 24-hour urinary metanephrines (99% sensitivity) ​is useful. Abdominal CT has also been shown to be helpful. Howeveron MRI, pheochromocytomas demonstrate a distinctive appearance ​(100% sensitivity), and scintigraphy ​using metaiodobenzylguanidine ​(a norepinephrine analog) labeled with I-131 (I-MIBG) is particularly good at locating extra-adrenal pheochromocytomas. ​+    * Plasma ​metanephrines (95% sensitivity)24-hour urinary metanephrines (99% sensitivity),​ MRI (100% sensitivity, pheochromocytomas demonstrate a distinctive appearance),​ scintigraphy, and abdominal CT.[([[https://​www.clinicaladvisor.com/​home/​features/​an-incidental-finding-twice-removed-in-an-anxious-patient/​|Clinical Advisor: An incidental finding, twice removed in an anxious patient]])]
 ===== Investigations ===== ===== Investigations =====
   * TSH, glucose as baseline if not already done   * TSH, glucose as baseline if not already done