Intended for healthcare professionals

Endgames Case Review

A 44 year old woman with episodic sweating and hypertension

BMJ 2019; 367 doi: (Published 31 October 2019) Cite this as: BMJ 2019;367:l5879
  1. Mehdi Mirzazadeh, consultant in metabolic medicine1,
  2. Ehsan Alijani, consultant physician2,
  3. Mahdieh Fani, clinical educator3,
  4. Shahin Jamili, consultant surgeon2
  1. 1Epsom and St Helier Hospital University Hospital NHS Trust, London, UK
  2. 2Noor Hospital,Tehran, Iran
  3. 3Cardiff University, Cardiff, UK
  1. Correspondence to M Mirzazadeh mehdi.mirzazadeh{at}

A 44 year old woman with hypertension and type 2 diabetes (treated with insulin) presented with recurrent 10-15 minute episodes of sweating, tachycardia with regular pulse (110-120 beats/minute), pallor, and occasional increase in blood pressure (from ~130/90 mmHg to ~175/120). These episodes happened two to three times a week over eight months.

Glucose readings during these episodes were always greater than 8 mmol/L, ruling out hypoglycaemia.

Her medications included doxazosin, metformin, and insulin. She had a body mass index of 32 kg/m2. Physical examination, baseline blood tests, and renal artery doppler were normal.

Further investigations were carried out as outlined …

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