Why would I have such a dramatic spontaneous fluctuation in my blood pressure? What could be my problem? I' am a 28 year old male in fairly fit condition but for the last three years I have had episodes of dramatic fluctuations in my blood pressure. My no

The . The most important cause to rule out in situations like this is the presence of a tumor of the adrenal gland, called a pheochromocytoma. Even with these symptoms such a tumor is rarely found. The diagnosis can usually be made by analysis of a 24 hour urine collection or by blood tests. Other possible causes of these types of symptoms include: panic attacks, labile hypertension, anxiety, hyperthyroidism, migraine headaches, central nervous system lesions, seizures, carcinoid syndrome, drugs (including cocaine, lsd, amphetamines, and others), and tyrosine ingestion combined with monoamine oxidase inhibitors (which are a type of antidepressant drug). In many patients with episodic hypertension in whom a pheochromocytoma is not found the cause remains unknown, and treatment is difficult. The symptoms most likely involve activation of the sympathetic system, but the cause of sympathetic activation is unclear. It may stem from emotional factors that are repressed from conscious awareness. This condition is sometimes called pseudopheochromocytoma, and most often includes rapid elevation of blood pressure; sudden onset of physical symptoms, such as headache, chest pain, dizziness, nausea, palpitations, flushing, and/or sweating; and a lack of emotional causes, such as fear or panic, although fear can occur as a result of the worrisome physical symptoms. Episodes can last from ten minutes to several hours; they can occur several times per day or only once every few months. Between episodes the blood pressure may be normal or mildly elevated.