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Medicine MCQ

 Question:

A 45-year-old woman presents with episodic palpitations, headache, and sweating. On examination, her blood pressure is 180/110 mmHg, and she has tachycardia. Laboratory tests reveal elevated plasma metanephrines. What is the most likely diagnosis?

Options:

A. Hyperthyroidism

B. Essential hypertension

C. Pheochromocytoma

D. Cushing’s syndrome

✅ Answer: C. Pheochromocytoma




Explanation:

Clinical triad: episodic headache, palpitations, and sweating are classic for pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla.

Paroxysmal hypertension is common; sustained hypertension may also be seen.

Lab findings: elevated plasma or urinary metanephrines confirm catecholamine excess.

Differential diagnosis:

Hyperthyroidism → palpitations, tachycardia, weight loss, heat intolerance; usually no episodic severe hypertension.

Essential hypertension → chronic, not paroxysmal; no catecholamine excess.

Cushing’s syndrome → features include central obesity, moon face, striae, hypokalemia, but not paroxysmal hypertension.

Imaging: CT or MRI of adrenal glands helps locate the tumor.

Management:

Preoperative alpha-blockade (e.g., phenoxybenzamine) followed by beta-blockade for tachycardia.

Surgical adrenalectomy is definitive treatment.

Complications if untreated: hypertensive crisis, arrhythmias, myocardial infarction, stroke.




References: Harrison’s Principles of Internal Medicine, 21st Edition, Ch. 230; 

UpToDate: Pheochromocytoma and paraganglioma.

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