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Clinical Review Quiz

Pheochromocytoma

Mary Ann Nguyen-Martin, MD, and Gary D. Hammer, MD, PhD

Dr. Nguyen-Martin is a fellow, Division of Metabolism, Endocrinology, and Diabetes, and Dr. Hammer is an associate professor, Department of Internal Medicine; both are at the University of Michigan, Ann Arbor, MI.


The questions below are based on the article
“Pheochromocytoma”.

Choose the single best answer for each question.


1. All of the following are common signs and symptoms of pheochromocytoma EXCEPT
  1. Abdominal pain
  2. Nausea
  3. Pallor
  4. Weight gain
Click here to compare your answer.


2. Which of the following statements about pheochromocytoma is NOT true?

  1. The classic triad of headache, diaphoresis, and palpitation has a diagnostic sensitivity greater than 92%
  2. Pallor is seen more commonly than flushing
  3. Orthostatic hypotension along with suggestive symptoms is highly specific for the diagnosis
  4. Cholelithiasis can be seen in 3% to 23% of patients
Click here to compare your answer.


3. Pheochromocytomas may secrete all of the following EXCEPT

  1. Calcitonin
  2. Dopamine
  3. Epinephrine
  4. Norepinephrine
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4. All of the following can be used for the preoperative management of pheochromocytoma EXCEPT

  1. Dopamine
  2. Metyrosine
  3. Nifedipine
  4. Prazosin
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5. All of the following are appropriate measures for managing pheochromocytoma EXCEPT

  1. Observation for hypoglycemia in the immediate postoperative period
  2. Preoperative medical blockade with a ß- adrenergic blocker and metyrosine 2 weeks prior to surgery
  3. Lifelong steroid replacement for patients undergoing bilateral adrenalectomy
  4. Allow patients liberal salt intake 10 to 14 days prior to surgery
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6. A 48-year-old man reports frequent episodes of headache and diaphoresis. He has also had 2 episodes of nephrolithiasis in the past 6 months. A few years ago, he was diagnosed with medullary thyroid carcinoma. He is worried that his recent symptoms may be related to his thyroid carcinoma. Based on this patient’s symptoms and past medical history, you would like to do genetic testing. Which genetic mutation is the most likely cause of all of this patient’s symptoms?
  1. RET
  2. von Hippel-Lindau
  3. Neurofibromatosis type 1
  4. Succinate dehydrogenase subunit D
Click here to compare your answer.


7. In evaluating a patient who is at low risk for pheochromocytoma, which biochemical test yields the least number of false-positive results?

  1. Plasma free metanephrine
  2. Plasma norepinephrine
  3. Urinary catecholamines
  4. Urinary metanephrine
Click here to compare your answer.


8. A 33-year-old woman who is 16-weeks pregnant presents to the emergency department with worsening abdominal pain over the past 3 weeks. She has also had episodes of palpitations and nausea, which she believes are related to the pregnancy. Her blood pressure is 184/96 mm Hg, her heart rate is 98 bpm, and her plasma free metanephrine level is 356 ng/L. You would like to perform an imaging study. Which is the best test for this patient?

  1. Computed tomography scan
  2. Magnetic resonance imaging
  3. Metaiodobenzylguanidine
  4. Positron emission tomography scan
Click here to compare your answer.


 

Pheochromocytoma
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