Assignment Task:
Patient: Petakki, Warren
ACCOUNT/EHR #: PETAWA001
HISTORY: This 35-year-old male has been referred to me by Dr. Waterman with an elevated blood pressure (188/112, seated) at his yearly physical exam. Previous exams noted blood pressures of 160/94 and 158/92. On questioning, patient admits 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 each.
PHYSICAL EXAM: Thirty minutes after the initial blood pressure measurement, the seated blood pressure is 178/110 with a heart rate of 90. The blood pressure after 3 min of standing is 152/94 with a heart rate of 112. The optic fundi showed moderately narrowed arterioles with no hemorrhages or exudates.
LABS (Labs performed day prior to consultation): Routine hematology and chemistry studies are within the reference ranges and a chest film and EKG are essentially normal. A 24-hour urine specimen is collected for analysis of catecholamines and catecholamine metabolites. Plasma catecholamines are also assayed. Urinary catecholamines and catecholamine metabolites are all elevated. Plasma norepinephrine is markedly elevated, but epinephrine is within the normal range. A CT scan of the adrenals revealed an 8-cm mass on the left side.
DX: Pheochromocytoma
CLINICAL COURSE: Treatment options are discussed with the patient. The patient is treated with alpha and beta-blockers (catecholamine receptor blocking agents) for several weeks. Abdominal surgery for removal of the pheochromocytoma will be scheduled once patient's BP is down. Want Online Tutoring?
Derrick Alexander, MD
CC: Dr. Waterman