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Phaeochromocytoma Screening — MRCP Part 1 MCQ

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MediumEndocrinologyPhaeochromocytoma ScreeningMRCP Part 1UKMLAPARAPSA

A 55-year-old woman presents with a 1-year history of intermittent headaches, sweating episodes, and palpitations. Her blood pressure is found to be 170/105 mmHg despite taking Ramipril and Amlodipine. What investigation is most appropriate to screen for an underlying cause?

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Correct answer: A — 24-hour urinary fractionated metanephrines

The triad of episodic headaches, sweating, and palpitations, particularly in the context of resistant hypertension, should raise suspicion of a phaeochromocytoma (a catecholamine-secreting tumour). The recommended screening test according to NICE NG136 and CKS is measurement of plasma free metanephrines or 24-hour urinary fractionated metanephrines (catecholamine metabolites). Aldosterone:renin ratio is for Conn's syndrome (hyperaldosteronism). Dexamethasone suppression test is for Cushing's syndrome. Renal Doppler is for renal artery stenosis. Sleep studies are for obstructive sleep apnoea.

Reference: NICE NG136: Hypertension in adults / CKS: Phaeochromocytoma