A 45-year-old man with episodic headache, palpitations, and sweating, and elevated plasma metanephrines is most likely to have:

A Pheochromocytoma

B Addison's disease

C Hyperthyroidism

D Insulinoma

Solution

Correct Answer: Option A

The patient’s episodes of headache, palpitations, and sweating alongside elevated plasma metanephrines strongly indicate pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla. Plasma metanephrines are the most sensitive diagnostic markers for pheochromocytoma. Key management involves preoperative alpha-adrenergic blockade to control hypertension and prevent intraoperative hypertensive crises, followed by surgical resection of the tumor. Early diagnosis and careful perioperative management are crucial to avoid life-threatening cardiovascular complications.

Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.

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