Factitious Pheochromocytoma Associated with Self-Injection of Epinephrine

• headache?

• tremor?

• tachycardia?

• hypertension?

• history of anxiety, depression or drug abuse?

• close contact with health care (self, friend or relative)?

• evidence of self-injection?

• history of factitious disease?

• history of multiple previous physicians, hospitalizations and/or surgery?

• elevated serum levels of epinephrine?

• marked variation in the serum levels of epinephrine between different samples?

• normal serum norepinephrine levels?

• normal clonidine suppression test?

• normal serum chromogranin A levels?

• increased urinary epinephrine levels?

• low to normal urinary norepinephrine and catecholamine metabolite levels?

• normal adrenal glands on CT or MRI scans?

• normal scan with 131-metaiodo-benzylguanidine (131-MIBG)?