Step 1: View clinicals

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.

Step 2: Order all relevant investigations

Thyroid Profile

TSH: 2.4 mU/L (0.5-5) T4: 15.6 pmol/l (8 - 27) T3: 1.5 nmol/l (1- 2.6)

MRA Renal Vessels

The renal vasculature appears completely normal.

MRI Abdomen & Pelvis

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 Metanephrines

24h Urinary Fractionated Metanephrines: 2100 mcg/24 hours (<1,300)

Step 3: Select appropriate management

Beta Blockers
Surgical Resection

Score: ★★☆