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Pheochromocytoma — ABIM Board MCQ

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HardEndocrinology/MetabolismPheochromocytomaABIM Board

A 41-year-old has episodic palpitations, diaphoresis, headache and severe hypertension. His father had an adrenal tumor, and he is not taking a sympathomimetic. Which initial biochemical test is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Measure plasma free metanephrines under standardized collection conditions

The best answer is “Measure plasma free metanephrines under standardized collection conditions”. Plasma free metanephrines or urinary fractionated metanephrines are sensitive initial tests because catecholamine metabolites are produced continuously. Proper resting collection reduces false positives. Imaging localizes disease after biochemical evidence, while cortisol, gastrin and thyroid antibodies address other endocrine disorders.

Reference: Endocrine Society Pheochromocytoma and Paraganglioma Guideline: https://www.endocrine.org/clinical-practice-guidelines/pheochromocytoma-and-paraganglioma