Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.