A 40 years old lady comes with Pheochromocytoma. Most characteristic symptom is?

ANSWER: (D) Paroxysmal hypertensionREF: Harrisons Internal Medicine chapter 337 Pheochromocytoma Table 337-1Repeat December 2009, June 2010Pheochromocytomas and paragangliomas are catecholamine-producing tumors derived from the sympathetic or parasympathetic nervous system. These tumors may arise sporadically or be inherited as features of multiple endocrine neoplasia type 2.The "rule of tens" for pheochromocytomas states that about 10% are bilateral, 10% are extraadrenal, and 10% are malignant. However, these percentages are higher in the inherited syndromes.The clinical presentation is so variable that Pheochromocytoma has been termed "the great masquerader". The dominant sign is hypertension. Classically, patients have episodic hypertension, but sustained hypertension is also frequent.CLINICAL FEATURES ASSOCIATED WITH PHEOCHROMOCYTOMAHeadachesWeight lossSweating attacksParadoxical response to antihypertensive drugsPalpitation and tachycardiaPolyuria and polydipsiaHypertension, sustained or paroxysmalConstipationAnxiety and panic attacksOrthostatic hypotensionPallorDilated cardiomyopathyNauseaErythrocytosisAbdominal painElevated blood sugarWeaknessHypercalcemia