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Correspondence
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Volume 328:290 January 28, 1993 Number 4
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Clinical Problem-Solving: Interpreting Hoofbeats: Can Bayes Help Clear the Haze?

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To the Editor: The pheochromocytoma-imitating condition described in the recent Clinical Problem-Solving article by Pauker and Kopelman (Oct. 1 issue)1 is a very frequent one2. The authors correctly analyzed the methodologic pitfalls of determinations of urinary vanilmandelic acid, but failed to mention that even the condition of patients with essential hypertension who have low conjugated catecholamine levels may imitate pheochromocytoma clinically and that they may have falsely elevated plasma and urinary catecholamine levels3. The degree of catecholamine sulfoconjugation is reflected by the level of plasma norepinephrine and epinephrine sulfates. Hypertensive patients with plasma levels of norepinephrine and epinephrine . . . [Full Text of this Article]

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