Medical Mystery: A fitness fanatic runs into an ailment that was caught in the nick of time

Barry Goldsmith went to great lengths to stay out of the doctor’s office.

His belief in the power of exercise — particularly, running — to keep him fit and healthy had long been an article of faith. If he weren’t feeling well, Goldsmith would lace up his shoes and “run it off.” The Maryland patent lawyer routinely racked up about 30 miles a week — more when he was training for a marathon or triathlon — interspersed with swimming, cycling and weight training.

But several years ago, Goldsmith, now 56, experienced a series of alarming episodes he couldn’t outrun.

They followed a pattern: First, a rush of what felt like acid would shoot up Goldsmith’s legs. Then came 10 minutes or so of pounding heart palpitations that ended with a wave of nausea.

At first, the episodes were sporadic. But eventually they increased in frequency and duration, leaving Goldsmith crumpled on a neighbor’s lawn at the start of a run.

Goldsmith and his wife were shocked to learn his condition was potentially fatal and had been germinating for years, partly camouflaged by his stellar level of fitness.

“Being in good physical health was a blessing and a curse,” Goldsmith said. “The longer I waited, the more I put myself at risk.”

Goldsmith first noticed the problem in 2014 at the end of a cross-country flight. Landing in California, he stood up and felt the rush of acid, palpitations and nausea, which subsided fairly quickly.

In 2015, he developed occasional morning headaches. Goldsmith consulted the cardiologist he had seen as a precaution for a low heart rate, which can result from vigorous exercise, but did not mention the episodes. The doctor said that Goldsmith appeared to be healthy.

By 2016, the morning headaches were occurring more often. At times, Goldsmith felt tired, but assumed he was getting older or hadn’t slept well.

But during a 5K race in July 2017, Goldsmith felt so weak that he had to stop midway and walk to the finish line. The palpitations and nausea were more frequent.

An endocrinologist suggested he might want to try thyroid medication. An ophthalmologist friend suggested that he might be experiencing blood pressure spikes, even though his readings in doctors’ offices were normal.

At his friend’s suggestion, Goldsmith bought a blood pressure cuff. One time, he registered 204/118, a reading consistent with a hypertensive crisis, which can require emergency treatment. At other times they were normal, about 125/85.

In December, Goldsmith finally acceded to his wife’s wishes and saw one of his internist’s partners. His blood pressure reading in the office was a worrisome 170/87 and his blood pressure medication dose was increased.

In January 2018, Goldsmith returned to the endocrinologist, who ordered blood tests to check Goldsmith’s hormone levels and convinced him to start taking a low dose of medicine for his underactive thyroid.

He kept feeling worse, and developed a new symptom: profuse sweating. In May, he collapsed onto a neighbor’s lawn less than a mile into a run with friends.

Barry Goldsmith went online to see what he could learn about the causes of blood pressure spikes. References to a rare, typically benign tumor of the adrenal gland called a pheochromocytoma -- linked with just 0.2 percent of hypertension cases -- kept popping up. The symptoms sounded familiar: sudden hypertension or blood pressure spikes, profuse sweating, rapid heart rate, weakness and headaches. These result when the tumor releases uncontrolled bursts of hormones including adrenaline, particularly in response to physical exertion or stress.

Goldsmith emailed his internist and asked whether it was possible that he had such a tumor, known in medical jargon as a “pheo.”

The internist replied that it was and told him to call the endocrinologist.

A week later, he was back in her office. The doctor told him that one of the blood tests she had ordered six months earlier — which he had skipped due to an aversion to needles — could have helped answer this question. It measured the level of catecholamines — hormones secreted by the adrenal glands, the paired organs atop the kidneys. Elevated levels of these hormones can signal an endocrine tumor.

Goldsmith’s levels turned out to be far above normal. A CT scan revealed an enormous tumor, roughly the dimensions of a small acorn squash, engulfing his right adrenal gland. Pheos often develop for unknown reasons, but in at least 25 percent of cases, genetic factors play a role. Doctors consider the tumors a “time bomb”; they can cause a stroke, kidney failure, heart attack or sudden, unexplained death. Treatment typically involves surgery to remove the tumor, along with the affected adrenal gland.

Goldsmith’s endocrinologist immediately called Washington endocrine surgeon Erin Felger.

For a nerve-wracking two weeks before the June 29 procedure, Goldsmith had to take drugs to stabilize his blood pressure. Every morning, his wife, Paula, said, she awoke wondering whether he was still alive. “I didn’t want to leave his side,” she recalled.

Six weeks after surgery, with Felger’s approval, Goldsmith resumed running, although initially at a slower pace and a reduced distance. His blood pressure remains slightly elevated, which is common after surgery. He will require lifelong monitoring to make sure the tumor doesn’t recur, which is rarely the case.

In the months before his diagnosis, Goldsmith said, fear was an obstacle: He was increasingly afraid of what doctors might find. In retrospect, he wishes he’d acted with greater dispatch. “I could have saved a few years,” he said.