What is the SINGLE most likely diagnosis for a 32-year-old man with paroxysmal hypertension and profuse sweating?

The scenario describes a 32-year-old man experiencing paroxysmal hypertension and profuse sweating, which are classic symptoms associated with pheochromocytoma, a type of tumor that arises from the adrenal medulla. Pheochromocytomas are primarily known for secreting catecholamines, such as epinephrine and norepinephrine, leading to episodes of hypertension and other sympathetic overactivity symptoms, including sweating, palpitations, and headaches. The paroxysmal nature of the hypertension—meaning it occurs in sudden, episodic bursts—along with the sweating, aligns strongly with this diagnosis.

While hyperthyroidism can cause increased sweating and hypertension, the hallmark symptoms often include weight loss and tremors, and it typically does not present with paroxysmal episodes of hypertension in the same way. Panic attacks can lead to symptoms of anxiety and sweating but usually do not manifest as significant hypertension. Essential hypertension is a chronic condition without the episodic spikes and accompanying sweating; it generally is not characterized by the acute autonomic symptoms observed in this case.

Thus, pheochromocytoma stands out as the most likely diagnosis due to its characteristic symptoms and the acute episodic nature of hypertension associated with catecholamine release from the tumor