00:00
Let's go on
to another case.
00:03
A25-year-old male presents
to the emergency department
with a severe pulsatile
headache for one hour.
00:09
He says that he's having
palpitations and sweating.
00:12
He adds that he has had several
similar episodes in the past
which resolved without
seeking medical attention.
00:20
He is a nonsmoker and does
not drink alcohol.
00:23
He denies the use
of any illicit drugs.
00:26
He looks anxious
and diaphoretic.
00:29
His temperature is
37 degrees Celsius.
00:31
His respirations are
25 breaths per minute.
00:34
Pulse rate is 107 and
blood pressure is 228/160.
00:40
A CT scan of the abdomen
reveals an adrenal mass.
00:44
What is the next step in the
management of this patient?
Based on the
clinical suspicion
formulated by the presentation
of this patient,
a pheochromocytoma or an
adrenaline-secreting tumor
of the adrenal gland is very
high on the differential.
01:04
Usually, this manifests
as the classic triad
of diaphoresis, headache,
and tachycardia.
01:11
CT scan findings also suggest
that there is an adrenal mass
which would go along
with the diagnosis.
01:18
The next best step in the
management of this patient
would be to order a 24-hour urine
metanephrine and catecholamine level
to confirm
the diagnosis.
01:28
Phenoxybenzamine is a non-competitive
alpha blocker
and is given 7-10 days
prior to surgery
for patients needing resection
for their pheochromocytoma.
01:38
This medication blocks alpha
receptors in blood vessels.
01:42
This is then followed
by beta blockade
using a non-selective beta
blocker like propranolol
which acts on the beta receptors
in the heart and kidney
to lower blood
pressure further.
01:54
Beta blockade
should be done
when all the alpha-1 receptors
are already blocked
or else the circulating
catecholamines
may stimulate alpha-1 receptors
precipitating a hypertensive crisis.
The lecture Adrenal Case: 25-year-old Man with Severe Pulsatile Headache by Michael Lazarus, MD is from the course Adrenal Gland Disorders.
What is the best next step in the management of a patient with suspected pheochromocytoma?
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