A 34-Year-Old Man With a Severe Headache and Profuse Sweating: Osmosis USMLE Question

August 09, 2019

Answer: E. Pheochromocytoma

This man most likely has a pheochromocytoma, a rare tumor derived from the adrenal medulla that secretes the hormones of that organ: norepinephrine, epinephrine, and dopamine.

Pheochromocytoma is characterized by paroxysmal hypertension in a young person associated with the triad of headaches, sweating, and palpitation. The best test for confirming pheochromocytoma is a finding of elevated plasma free metanephrine. The most practical and best confirmatory test for pheochromocytoma is urine vanillylmandelic acid (VMA) assessment. Surgical resection of the tumor is the treatment of first choice, either by open laparotomy or laparoscopy. Given the complexity of perioperative management, and the potential for catastrophic intraoperative and postoperative complications, such surgery should be performed only at centers experienced in the management of this disorder. In addition to the surgical expertise that such centers can provide, they also have the necessary endocrine and anesthesia resources.

Major Takeaway: Pheochromocytoma is a rare tumor derived from the adrenal medulla that secretes the hormones of that organ. It causes sympathetic hyperactivity, and the "classic triad" of symptoms are episodic sweating, headache, and tachycardia. The characteristic sign accompanying these symptoms is hypertension.

Read more about pheochromocytoma.

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