AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: Hi,
Over a year ago I was seeing an endocrinologist who was performing testing to look for a pheochromocytoma. I was spiking markers in my urine for a pheo tumor. I had higher than normal levels of catecholamines, epinepherine and norepinepherine. I had a Gamma scan with contrast and that test came up negative. I would have bad spikes in my blood pressure that would give me headaches, rapid heartbeat, dizziness, and tiny bleeds and a twisted vein in my retinas (hypertensive retinopathy). I unexpectly became pregnant and all testing to look for a pheo stopped due to the pregnancy. I saw a high risk maternal fetal med OB and he started me on methyldopa during my pregnancy for the bp issues. Eventually the attacks stopped towards the end of my pregnancy. I have stayed on the methyldopa to this day because I am afraid to change to another medication as I understand that it blocks epinepherine and norepinepherine and those attacks I had made me feel like I was going to die. Do you think the issue resolved itself or do you think the methyldopa is masking the issue? What would you recommend I do now?
ANSWER: It is hard to say without additional information about you. If you let me know where you live I might be able to recommend someone to see you who would be skilled in this area of medicine. If you are not close to someone who could see you then let me know and I will have a few other questions to ask and I might be able to provide some insight into your situation.
Best regards,
Domenic Sica, M.D.
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QUESTION: I live in Northeast Ohio. I did at one time see a hypertension Dr at the Cleveland Clinic and he didn't do anything because I couldn't reproduce the same 24 hour urine test results on demand. I couldnt even get him to take my records to the Pheo specialist they have there for review. Whatever this is happens sporadically- it is not a daily occurance and I can't predict when it is going to happen. When it does happen my heartrate can be as high as 134 bpm and my blood pressure 150-180 over 90-110. The positive 24 hour urine test I had happened to fall during one of these attacks. Even now with the methyldopa I cannot take certain medications like benadryl, tagamet, or even caffeine because it gives me a racing heartbeat.
ANSWER: This is not the easiest of situations as you nicely describe. I do have a couple of patients with circumstances similar to yours in whom I am using similar medication(s). You might consider keeping a diary of these events with time of day, frequency, duration, what you were doing at the time of the spell and whether the spell spontaneously resolved on its own. If i see that diary then I could possibly identify some triggers and offer additional advice.
Regards,
Domenic Sica, M.D.
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QUESTION: Do you have at least an educated guess on the root cause of these attacks? The endo tried giving me procardia one time and my blood pressure and heart rate went nuts for days until he stopped the medication. Same thing with another bp drug the hypertension Dr tried. It was a combo drug with spironolactone and something else. Lisinopril made me feel very sleepy and my heart rate varied between racing and very slow. These episodes eventually resolve themselves- but are very miserable when they are happening. Basically I am grasping at straws and looking for anything that might at least point me to the problem I am having. Everytime a Dr mentions changing my blood pressure medication I cringe and refuse. To date- I wont even take a tylenol for a headache because medications scare me. If I never have another one of those attacks it would be too soon. I appreciate your time.
Answer There are certain patients in whom there is an inappropriate release of the flight-or-fright hormones (catecholamines) in whom a pheochromocytoma is not present. In caring for such patients the usual triggers include stress, anxiety, depression, altered sleep patterns, pain, coronary artery disease or renovascular disease. I do not know if any of these are applicable to you. In choosing therapies for what you have Procardia is typically not the best choice, a drug like Aldomet is an appropriate choice. If Cleveland is close to where you live I might be able to put you in touch with a hypertension expert or two in that part of the country.
