A young patient affected by hypertensive crises: when medical history lies

A 21 years old man was admitted to the Emergency Department for throbbing headache and flushing associated with very high blood pressure, as confirmed by the ABPM performed in hospital. These symptoms are usually due to the excess of circulating catecholamines, so the differential diagnosis included pheocromocytoma and street drugs abuse, in particular cocaine. The patient repeatedly denied drugs absumption and the urine toxicological test at the time of the admission was negative.The laboratory and imaging tests excluded a pheocromocytoma. The cocaine use was confirmed by the hair toxicological test. A few number of cases is available in literature where a long duration of symptoms from the last cocaine absumption can be found. In these cases the hair toxicological test is resolutive for diagnosis.