Pheochromocytoma

A 45-year-old female is brought to the emergency department after collapsing at home. She reports feeling lightheaded with chest tightness before losing consciousness for a few seconds. Over the past two years, she has experienced recurrent episodes of palpitations, dyspnea, and transient visual disturbances. She also complains of intermittent tingling in her fingers and toes. She has a 15-pack-year smoking history but denies alcohol use. Her GP recently started her on amitriptyline for anxiety. Family history is significant—her mother died of a brain hemorrhage at age 50.

Examination: BP: 178/68 mmHg, Pulse: 82 bpm (regular), CVS: 2/6 pansystolic murmur (apex), nervous system: No focal deficits, but mild tremors and hyperhidrosis

Investigations:

• Haemoglobin (Hb): 7 g/dL
• Potassium (K⁺): 2 mmol/L
• Glucose:          8 mmol/L
• Corrected calcium: 58 mmol/L
• CXR/Abdominal exam: Normal
• ECG: Sinus rhythm, no ischemia
• Urine dipstick: Glucose (++), Blood (+)

What is the most likely diagnosis?

A 42-year-old male presents to the hypertension clinic with a 3-month history of episodic headaches, dizziness, and vague central abdominal discomfort. He reports unintentional weight loss of 4 kg despite a normal appetite. His blood pressure is 154/92 mmHg. On examination, a firm, non-tender thyroid nodule is palpated. Previous investigations ordered by his family physician show:

• Corrected calcium: 2.76 mmol/L (normal 2.20-2.60)
• Normal oral glucose tolerance test
• Normal renal function tests

Which one of the following is most likely to be the cause of his hypertension?

A 45-year-old woman presents with episodic headache, palpitations, and diaphoresis. Laboratory evaluation reveals markedly elevated plasma metanephrines. Abdominal imaging shows a 4.5 cm right adrenal mass. During genetic counseling, the physician discusses the “Rule of 10s” associated with pheochromocytoma. Which of the following is NOT included in this classic rule?

A 37-year-old male has had a history of hypertension for the previous 5 years. Currently, he is taking amlodipine, valsartan, and hydrochlorothiazide, but his hypertension remains uncontrolled. On examination, he has 160/100 mmHg, a pulse rate of 126/min. He had frequent episodes of apprehension, headache, and sweating, and started taking fluoxetine as advised by a psychiatrist. Which one is the appropriate next step?

A young patient with hypertension, episodic headache, and apprehension was investigated for the underlying cause. His TFTs and echo are normal, but his urinary Metanephrines are significantly raised. What should be the next investigation?

A 45-year-old woman is diagnosed with a left adrenal pheochromocytoma after presenting with episodic headaches, palpitations, and diaphoresis. Her blood pressure is currently well-controlled on no antihypertensive medications. She is scheduled for elective adrenalectomy in 3 weeks. Which of the following is the recommended initial medical treatment for this patient prior to surgery?

A 23-year-old male was recently diagnosed with pheochromocytoma and admitted to the surgical unit. The surgeon consulted you for his preoperative management. How will you manage this patient?