A 12 year old boy is referred for further evaluation of hypertension, which was detected incidentally at a school health screening program. He has experienced recurrent headaches, palpitations and episodic sweating for 2 months. The headaches lasted for short durations, and were generalized in nature. His medical and family histories are unremarkable, and he is not on any drugs. His full blood count, renal functions, serum electrolytes, and urinalysis are normal.
TSH: 2.4 mU/L (0.5-5) T4: 15.6 pmol/l (8 - 27) T3: 1.5 nmol/l (1- 2.6)
The renal vasculature appears completely normal.
There is a right-sided 3.2 × 2.4 cm suprarenal mass, and a left-sided 2 × 1 cm suprarenal mass, both of which exhibit a salt and pepper enhancement pattern and a high signal intensity in the T2 weighted image.
24h Urinary Fractionated Metanephrines: 2100 mcg/24 hours (<1,300)