Snapshot A 40-year-old gentleman presents with episodic headaches and palpitations. Attributing it to his tendency to worry excessively, he put it off for several months until he began to sweat episodically too. In the clinic, his blood pressure is found to be elevated at 160/120 mmHg. Plasma metanephrines are elevated and an abdominal CT scan reveals an adrenal mass. Introduction Nonmalignant tumor of adrenal medulla most common adrenal tumor in adults (vs neuroblastoma, most common in children) composed of chromaffin cells that are normally stimulated by acetylcholine secretes catecholamines causing episodic hypertension Pathogenesis from chromaffin cells of neural crest origin Epidemiology 40-50 years old Rule of 10’s 10% malignant 10% bilateral 10% kids 10% extra-adrenal bladder, organ of Zuckerkandl (bifurcation of aorta) 10% calcify Associated conditions von Hippel-Lindau disease MEN 2A MEN 2B neurofibromatosis type 1 Presentation Symptoms are episodic 5 P’s Pressure (↑ BP) Pain (headache) Perspiration Palpitations (tachycardia) Pallor mediated by tumor secretion of epinephrine, norepinephrine, and dopamine Physical exam ↑ BP (diastolic and systolic increase due to alpha adrenergic stimulation resulting in vasoconstriction) Evaluation Serology ↑ free metanephrine level 24-hour urine collection for diagnostic confirmation ↑ vanillyl mandelic acid (breakdown of norepinephrine and epinephrine) ↑ metanephrines (more sensitive than VMA) Histology chromaffin cells with enlarged dysmorphic nuclei Differential Diagnosis Hyperthyroidism Carcinoid tumors Panic disorder Therapy resistant hypertension from obstructive sleep apnea Treatment In this sequence of events α-antagonist phenoxybenzamine to prevent unopposed α-action if β receptors are blocked β-blocker tumor resection Prognosis, Prevention, and Complications Prognosis very good with resection Complications metastases bones, lungs, and liver
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.17.4713) A 34-year-old woman comes to the emergency department complaining of severe headache and anxiety, diaphoresis, and palpitations for the last 30 minutes. She has had several similar episodes over the past few weeks. She has no significant past medical history and has a 10 pack-year smoking history. She takes no illicit drugs. Her blood pressure on arrival is 181/80 mmHg and her pulse is 134/min. If this patient was given propranolol, how would her blood pressure respond? QID: 108485 Type & Select Correct Answer 1 Hypotension due to beta-adrenergic receptor blockade 61% (162/267) 2 Hypotension due to alpha-1-adrenergic receptor blockade 7% (19/267) 3 Hypertension due to alpha-1-adrenergic receptor blockade 3% (7/267) 4 Hypertension due to alpha-1-adrenergic receptor stimulation 24% (63/267) 5 Hypertension due to alpha- and beta-adrenergic receptor blockade 2% (6/267) M 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.EC.13.64) A 34-year-old female presents to the emergency room with headache and palpitations. She is sweating profusely and appears tremulous on exam. Vital signs are as follows: HR 120, BP 190/110, RR 18, O2 99% on room air, and Temp 37C. Urinary metanephrines and catechols are positive. Which of the following medical regimens is contraindicated as a first-line therapy in this patient? QID: 104389 Type & Select Correct Answer 1 Phenoxybenzamine 23% (55/243) 2 Nitroprusside 17% (41/243) 3 Propranolol 34% (83/243) 4 Labetalol 6% (15/243) 5 Lisinopril 12% (29/243) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.12.110) A 40-year-old female presents with palpitations, headache, and episodic diaphoresis. On physical exam she has a blood pressure of 170/90 mmHg. Urine analysis shows elevated levels of vanillylmandelic acid. Figure A shows the histology of the adrenal gland. Hyperactivity of cells in which of the follow regions is likely responsible for this patient's symptoms? QID: 100411 FIGURES: A Type & Select Correct Answer 1 Region 1 2% (1/61) 2 Region 2 8% (5/61) 3 Region 4 15% (9/61) 4 Region 5 2% (1/61) 5 Region 6 72% (44/61) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (M1.EC.12.116) A 49 year-old-male presents with a primary complaint of several recent episodes of severe headache, sudden anxiety, and a "racing heart". The patient originally attributed these symptoms to stress at work; however, these episodes are becoming more frequent and severe. Laboratory evaluation during such an episode reveals elevated plasma free metanephrines. Which of the following additional findings in this patient is most likely? QID: 100417 Type & Select Correct Answer 1 Decreased 24 hour urine vanillylmandelic acid (VMA) levels 3% (3/117) 2 Episodic hypertension 80% (94/117) 3 Anhidrosis 3% (4/117) 4 Diarrhea 4% (5/117) 5 Hypoglycemia 5% (6/117) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (0) Endocrine | Pheochromocytoma Endocrine - Pheochromocytoma Listen Now 11:30 min 9/29/2021 44 plays 0.0 (0)