Antonio I: Under Pressure

Endocrine System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F2.jpg"}},{"insert":"\n\nThe endocrinology clinic can be quite challenging at times, but you\u0027ve had a quiet day so far. The door opens once more, and your next patient comes in: 32-year-old Antonio, who has been referred by his primary care physician. You introduce yourself, shake hands, and ask him to take a seat.\n\nYou peruse the referral letter. This states that Antonio\u0027s blood pressure was found to be 140\/90 mmHg at a routine health checkup. His blood pressure on the following day was 160\/95 mmHg. Antonio was asymptomatic, with unremarkable medical and family histories. He was not on any medications and denied using recreational drugs. The examination was unremarkable.\n\nA full blood count, serum sodium, potassium, and calcium levels, fasting plasma glucose, renal profile, liver profile, ECG and chest x-ray were normal. A thyroid profile, serum parathyroid hormone levels and an ultrasound scan of the neck were also normal. \n\nHowever, abdominal ultrasound revealed a 3.5 \u00d7 5 cm mass above the right kidney. The primary care physician suspected this might be a pheochromocytoma, and referred Antonio to your clinic for further management.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F5.jpg"}},{"insert":"\n\nYou put the referral letter down, take Antonio\u0027s history and perform an examination. However, you fail to elicit any new findings. You also peruse his investigation results and confirm the primary care physician\u0027s conclusions.\n"}]}


{"ops":[{"insert":"Acting on the assumption that this might indeed be a pheochromocytoma, you ponder what to do next.\n\nWhich of the following will you order?\n"}]}
1. Plasma free metanephrine + normetanephrine levels
2. 24-hour urine metanephrines + catecholamines
3. CT-guided percutaneous biopsy