A young women with longstanding hypertension and an abdominal tumor

A young women with longstanding hypertension and an abdominal tumor

Ali A Ghazi MD

 Professor of Internal Medicine and Endocrinology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

21. The patient was a 29 years old woman who was admitted with a history of palpitation, headache  and sweating since last 6 years.
21. She was will until 6 years ago when during a   maxillofacial surgery an attack of high blood pressure, 270/170 mmHg, was detected. surgery was canceled and further evaluation was advised.
21. A 24 h urine evaluation revealed a normetanephrine of 8ooµg/day( 30-440), metanephrine 68 µg/day ( 20-345) and VMA, 17mg/day ( less than 12).
21. Abdominal US, CT scan and MRI was normal.
21. Further evaluation including MIBG scan was refused by the patient.
21. She was discharged on 5 mg prazosin and 25 mg atenolol.
21. The headache, palpitation and hypertension in the range of 170/110 persisted.
21. Six months ago the patient came to us because of aggravation in headache and hypertension.
21. Major complaint s were headache and palpitation. She looked mildly anemic. BP was 180/110 mm Hg and . Rest of physical exam including heart and lung evaluation were negative.
21. Routine lab was normal except for mild anemia (Hb=10.6).
21. Urine evaluation for catecholamine metabolite showed
21. Metanephrine:            114 µg/day     <350
21. Normetanephrine:    >3000 µg/day   <600
21. VMA:                         20.3 mg/day   <13.6