03-05-2012, 06:38 AM
Sweating and palpitations
Q. A 33-year-old man comes to the office complaining of 3 months of severe headaches preceded by sweating and palpitations. He denies any chest pain or shortness of breath with these episodes. He has not taken any new medications and denies excessive caffeine intake and illicit drug use. His temperature is 37.0 C (98.6 F), blood pressure is 120/70 mm Hg, pulse is 78/min, and respirations are 14/min. Physical and neurological examinations are unremarkable. Thyroid function tests, a complete blood count, and a 24-hour urine cortisol are all within normal limits. Urine catecholamines are elevated. You order a CT scan of the abdomen, which shows an adrenal mass. The most appropriate next step is to
A. begin therapy with phenoxybenzamine
B. begin therapy with propanolol
C. consult a surgeon for emergent laparoscopic adrenalectomy
D. order serial CT scans to evaluate progression
E. perform a fine needle aspiration of the mass
Q. A 33-year-old man comes to the office complaining of 3 months of severe headaches preceded by sweating and palpitations. He denies any chest pain or shortness of breath with these episodes. He has not taken any new medications and denies excessive caffeine intake and illicit drug use. His temperature is 37.0 C (98.6 F), blood pressure is 120/70 mm Hg, pulse is 78/min, and respirations are 14/min. Physical and neurological examinations are unremarkable. Thyroid function tests, a complete blood count, and a 24-hour urine cortisol are all within normal limits. Urine catecholamines are elevated. You order a CT scan of the abdomen, which shows an adrenal mass. The most appropriate next step is to
A. begin therapy with phenoxybenzamine
B. begin therapy with propanolol
C. consult a surgeon for emergent laparoscopic adrenalectomy
D. order serial CT scans to evaluate progression
E. perform a fine needle aspiration of the mass