iatroX Rounds #23
The clues
- 1
A 32-year-old man presents with intermittent episodes of severe anxiety, heart racing, and a feeling of impending doom.
- 2
The episodes occur twice a week, last about 15 minutes, and are associated with a pale face and drenching sweats.
- 3
He has a background of hypertension that has required three different medications to control.
- 4
During an episode in the clinic, his blood pressure is recorded as 215/118 mmHg.
- 5
Initial screening reveals urinary metanephrines that are more than three times the upper limit of normal.
- 6
Cross-sectional imaging shows a large, heterogeneous, enhancing mass in the right adrenal gland that is bright on T2-weighted MRI.
A phaeochromocytoma is a rare catecholamine-secreting tumour arising from chromaffin cells, usually in the adrenal medulla. It presents with paroxysmal symptoms and is a crucial differential to consider in cases of resistant or secondary hypertension.
- Classic triad of episodic headache, sweating, and palpitations
- Paroxysmal or resistant hypertension
- Pallor during episodes due to intense alpha-mediated vasoconstriction
- Association with genetic syndromes like MEN2, von Hippel-Lindau, and Neurofibromatosis type 1
for education and entertainment. not medical advice.