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Idiopathic Neuropathy — RACP Adult Medicine MCQ

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HardNeurologyIdiopathic NeuropathyRACP Adult Medicine

A normotensive RET-MEN2 carrier has mildly elevated plasma metanephrines on a sample taken seated during acute pain while receiving a tricyclic antidepressant. What is the best next step?

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Reveal the answer and explanation

Correct answer: D — Repeat optimised biochemical testing after addressing confounders before localising imaging

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

A is correct. Borderline metanephrine elevation under non-standard conditions and drug/pain confounding should be repeated under optimised conditions before localising imaging. B is unsafe. C eviQ recommends biochemical surveillance, with imaging after suspicion. D normotension does not exclude disease. E calcitonin monitors medullary thyroid carcinoma, not phaeochromocytoma.

Reference: eviQ, RET (MEN2) risk management: https://www.eviq.org.au/cancer-genetics/adult/risk-management/1526-ret-men2-risk-management