Endocrine System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027re in the on-call room, basking in the comfort of a cup of tea, when your pager beeps.\r\n \r\nIt\u0027s the nurse, paging you to ER to see a new patient.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F2.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Antonio, 38 years old, looks distinctly uncomfortable and restless.\r\n \r\n\u0022I was at work when I suddenly began to have a severe headache and palpitations, around half-an-hour ago,\u0022 he says shakily, looking positively green.\r\n \r\n\u0022My stomach hurts, too. I think I\u0027m going to throw up.\u0022\n\nAs you place a kidney tray near him, you notice that he is perspiring.\r\n \r\nIt takes a moment for Mr. Antonio to collect himself, after which he tells you that he had similar symptoms around a month ago, which he attributed to exertion.\r\n \r\n\u0022I took some ibuprofen back then and felt fine.\u0022\n\nHe consumes around two glasses of wine a week and is a non-smoker with no significant medical history. He does, however, have a family history of diabetes mellitus.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F3.jpg"}},{"insert":"\n\n"},{"insert":"You begin checking Mr. Antonio\u0027s vitals. \r\n\r\nHis blood pressure is markedly elevated at 195\/110 mmHg; he has a regular pulse of 126 bpm, a temperature of 37.5 \u00b0C and a respiratory rate of 18 cycles\/min.\r\n \r\nHe also looks pale and sweaty. A systemic examination reveals no abnormalities.\n\nYou proceed to order an EKG, which reveals sinus tachycardia. You also decide to send for some basic labs.\n"}]}


{"ops":[{"insert":"Mr. Antonio\u0027s CBC, renal and liver function tests, electrolytes, and sugars all return unremarkably.\r\n\r\nSoon afterwards (around 15 minutes after his arrival), Mr. Antonio\u0027s symptoms resolve spontaneously, and he looks relieved. His blood pressure is now 140\/90 mmHg.\r\n \r\n\u0022I feel all right now, doctor, it must\u0027ve been the heat. I guess I\u0027ll get back to work,\u0022 he says, making to leave.\n\n\u0022Sure - but I\u0027d like to see you again in a couple of days\u0022, you say hurriedly.\r\n \r\nHe looks a little reluctant but agrees when you explain the need to rule out serious underlying disease.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M25_F5.jpg"}},{"insert":"\n\n"},{"insert":"A couple of days later, Mr. Antonio drops into your clinic. \r\n\r\nHis blood pressure is still elevated at 145\/95 mmHg; fundoscopy shows no evidence of hypertensive retinopathy.\r\n\r\nAfter some deliberation, you proceed to order a series of investigations.\n\nSubsequently, Mr. Antonio\u0027s thyroid functions, serum calcium and parathormone levels, chest X-ray, and ultrasound of the neck all turn out to be normal.\r\n \r\nHowever, an abdominal ultrasound reveals a mass of 3.5\u00d75 cm located above the right kidney.\n\nSuspecting a pheochromocytoma, you ponder the best way to confirm your diagnosis.\n"}]}