Adrenal Case: 25-year-old Man with Severe Pulsatile Headache – Endocrinology | Lecturio

Adrenal Case: 25-year-old Man with Severe Pulsatile Headache – Endocrinology | Lecturio


[Music] let’s go on to another case a 25 year old male presents to the emergency department with a severe pasa tile headache for one hour he says that he’s having palpitations and sweating he adds that he has had several similar episodes in the past which resolved without seeking medical attention he is a nonsmoker and does not drink alcohol he denies the use of any illicit drugs he looks anxious and diaphoretic his temperature is 37 degrees Celsius his respirations are 25 breaths per minutes pulse rate is 107 and blood pressure is 228 over 160 a CT scan of the abdomen reveals an adrenal mass what is the next step in the management of this patient based on the clinical suspicion of formulated by the presentation of this patient a free pheochromocytoma or a adrenaline secreting tumor of the adrenal gland is very high on the differential usually this manifests as the classic triad of diaphoresis headache and tachycardia CT scan findings also suggest that there is an adrenal mass which would go along with the diagnosis the next best step in the management of this patient would be to order a 24 hour urine methan Efren and catecholamine level to confirm the diagnosis phenoxy benz amine is a non-competitive alpha blocker and is given seven to ten days prior to surgery for patients needing resection for their pheochromocytoma this medication blocks alpha receptors and blood vessels this is then followed by beta blockade using a non-selective beta blocker like propanolol which acts on the beta receptors in the heart and kidney to lower blood pressure further beta blockade should be done when all the alpha-1 receptors already blocked or else the search circulating catecholamines may stimulate alpha wine receptors precipitating a hypertensive crisis [Music]

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