Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

Is non-conformity WEIRD? Cultural variation in adults' beliefs about children's competency and conformity

Cross-cultural comparisons provide critical insight into variation in reasoning about intelligence. In two studies, the authors used a novel methodology based on multivocal ethnography to assess the role of conformity in U.S. and Ni-Vanuatu adults' judgments of children's intelligence and, as a comparison trait, good behavior. In Study 1, there were cultural differences in the impact of conformity on U.S. and Ni-Vanuatu adults' judgments of children's intelligence and good behavior. When evaluating U.S. children only, U.S. adults were less likely to endorse high conformity children as intelligent, often citing creativity as a justification for their judgments. In contrast, Ni-Vanuatu adults were more likely to endorse Ni-Vanuatu high conformity children as intelligent. Ni-Vanuatu adults were also more likely to endorse high conformity children as well-behaved than U.S. adults. In Study 2, there were no effects of socioeconomic status on U.S. adults' evaluations of conformity. U.S. adults were less likely to endorse high conformity children as intelligent than Ni-Vanuatu adults. Taken together, the data demonstrate that beliefs about the relations between intelligence, conformity, and creativity vary within and across cultures. (PsycINFO Database Record

Local perceptions of changes in traditional ecological knowledge: a case study from Malekula island, Vanuatu

Traditional ecological knowledge (TEK) is a critical global resource that may be eroding amid social and environmental change. Here, we present data on local perceptions of TEK change from three communities on Malekula Island in Vanuatu. Utilizing a structured interview (n = 120), we find a common perception of TEK loss. Participants defined two key periods of TEK erosion (roughly 1940-1960 and 1980-present), and noted that TEK decline was driven both external (e.g., church) and internal (e.g., shifting values) processes. Erosion was perceived to more comprehensive in the worldview domain than in aspects of ethnobiological knowledge and practice. These data indicate the perceived fragility of TEK systems and the complexity of TEK change. TEK systems are critical to natural resource management, and data such as these will assist in designing nuanced responses to the ongoing loss of cultural knowledge and practice.

Perceptions of the value of traditional ecological knowledge to formal school curricula: opportunities and challenges from Malekula Island, Vanuatu

BACKGROUND

The integration of traditional ecological knowledge (TEK) into formal school curricula may be a key tool for the revitalisation of biocultural diversity, and has the potential to improve the delivery of educational objectives. This paper explores perceptions of the value of TEK to formal education curricula on Malekula Island, Vanuatu. We conducted 49 interviews with key stakeholders (local TEK experts, educators, and officials) regarding the use of the formal school system to transmit, maintain, and revitalise TEK. Interviews also gathered information on the areas where TEK might add value to school curricula and on the perceived barriers to maintaining and revitalising TEK via formal education programs.

RESULTS

Participants reported that TEK had eroded on Malekula, and identified the formal school system as a principal driver. Most interviewees believed that if an appropriate format could be developed, TEK could be included in the formal education system. Such an approach has potential to maintain customary knowledge and practice in the focus communities. Participants identified several specific domains of TEK for inclusion in school curricula, including ethnomedical knowledge, agricultural knowledge and practice, and the reinforcement of respect for traditional authority and values. However, interviewees also noted a number of practical and epistemological barriers to teaching TEK in school. These included the cultural diversity of Malekula, tensions between public and private forms of knowledge, and multiple values of TEK within the community.

CONCLUSIONS

TEK has potential to add value to formal education systems in Vanuatu by contextualising the content and process of curricular delivery, and by facilitating character development and self-awareness in students. These benefits are congruent with UNESCO-mandated goals for curricular reform and provide a strong argument for the inclusion of TEK in formal school systems. Such approaches may also assist in the maintenance and revitalisation of at-risk systems of ethnobiological knowledge. However, we urge further research attention to the significant epistemological challenges inherent in including TEK in formal school, particularly as participants noted the potential for such approaches to have negative consequences.