A 35 year old man presented with elevated blood pressure (188/112) at a yearly p

Question

A 35 year old man presented with elevated blood pressure (188/112) at a yearly physical exam. Previous exams noted BPs of 160/94, and 158/92. On questioning, he admitted episodes about twice a month of apprehension, severe headache, perspiration, rapid heartbeat, and facial pallor. These episodes had an abrupt onset and lasted 10-15 minutes.

On physical exam, 30 minutes after the initial blood pressure measurement, the seated blood pressure was 178/110 with a heart rate of 90. The blood pressure after 3 minutes of standing was 152/94 with a heart rate of 112. The optic fundi showed moderately narrowed arterioles with no hemorrhages or exudates.

Initial laboratory including routine hematology and chemistry tests were within the reference ranges. A chest X-Ray and EKG were essentially normal.

Additional laboratory tests revealed:

Patient Reference Range Metanephrines, urine 345 74-297 ug/day Vanillylmandelic acid,urine 12.5 1.4-6.5 mg/day Norephinephrine 2500 125-700 pg/mL Epinephrine 85 <90 pg/mL

Explanation / Answer

High levels in metanephrines,norephinephrine indicates the presence of tumour of the adrenal glands called pheochromocytoma.Adrenal glands are present on top of the kidneys.Tumours like these can cause release of too many hormones.This can cause high blood pressure,excessive sweating,headaches,fast hearbeats and tremors.So the case study of patient given clearly indicates the condition of pheochromocytoma

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