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Pheochromocytoma
- The NBME tests the classic triad: episodic headache, sweating and palpitations with paroxysmal hypertension 1
- Best initial test is plasma free metanephrines (or 24-hour urine fractionated metanephrines) 12
- Image the adrenals with CT or MRI only after biochemical confirmation 2
- Before surgery, start an alpha-blocker first (phenoxybenzamine), then add a beta-blocker 3
- A beta-blocker alone leaves alpha stimulation unopposed and can trigger a hypertensive crisis 3
- Think of MEN 2A/2B, von Hippel-Lindau and NF1 in young or bilateral cases 4
A 34-year-old woman has episodes of headache, sweating and palpitations. BP is 210/120 during an episode. What is the best initial test?
Plasma free metanephrines
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