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Phaeochromocytoma — RACP Adult Medicine MCQ

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EasyEndocrinologyPhaeochromocytomaRACP Adult Medicine

A 50-year-old man presents with episodic headache, diaphoresis, and palpitations occurring in paroxysms lasting 20 minutes. During an episode, BP is 240/140 mmHg. Between episodes, BP is 140/90 mmHg. 24-hour urine metanephrines and normetanephrines are markedly elevated. CT abdomen shows a 4 cm right adrenal mass with heterogeneous enhancement. What is the most likely diagnosis?

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Correct answer: D — Phaeochromocytoma

Paroxysmal hypertension with the classic triad (headache, diaphoresis, palpitations), markedly elevated urine metanephrines, and a heterogeneous adrenal mass is phaeochromocytoma. Pre-operative alpha-blockade (phenoxybenzamine for 10–14 days) followed by beta-blockade, then surgical resection is the management. Genetic testing (MEN2, VHL, SDH) should be offered.

Reference: Endocrine Society – 2014 – Phaeochromocytoma; ESA 2024