Question of the Week # 192

192) A 26-year-old man is evaluated for a history of recurrent headaches and palpitations for the past one month. At this time, he has no headache or palpitations. He denies any chest pain, dizziness or shortness of breath. His past history is unremarkable except for fleshy nodules over his trunk that have been present since adolescence and have been increasing in number. On physical examination, heart rate is 102/min; blood pressure is 168/100 (Lying) and 138/90 ( Standing). Skin examination reveals freckling in the inguinal region and several fleshy tumors on his back as shown in the picture:

An Electrocardiogram reveals Sinus Tachycardia. The most appropriate next step in management of this patient?

a. Biopsy of the tumors
b. Plasma Metanephrines
c. CT Scan of the abdomen
d. Intravenous fluids
e. 24-Hour holter monitoring

5 Responses

  1. B: plasma metanephrine to confrim pheo in this patient of NF1

  2. extremely good question . It’s a multilevel question . Genius !

    It’s indeed pheo that the patient is having : palpitation , headache that comes and goes .

    However , the picture clearly shows that it’s neurofibromas .

    we have to make an association between pheo and NF type 1 .
    otherwise we will be clueless as to what the vignette actual is telling . we might go ahead and pick biopsy . Hahha

    Familial form of pheochromocytoma :frequency of association
    1) MEN 2 : 30-50%
    2)Von hippel : 15-12 %
    3) NF type 1 : 1-5 %

    just my 2 cents 🙂

  3. B): paroxysmal headache, palpitation, hypertension, postural hypotension are features of Pheochromocytoma and It is associated with neurofibromatosis NF1.

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