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  #1  
Old 06-01-2012
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Question pheochromocytoma but CT unequivocal ... what next ?

A 50-year-old man is evaluated for a recent onset recurrent episodes of palpitations, sweating, and headaches. Medical history is otherwise unremarkable. He takes no medications.
On physical examination, the patient appears anxious. Temperature is 37C, blood pressure is 168/96 mm Hg, pulse rate is 88/min, respiration rate is 18/min, and BMI is 32.
Findings from a general physical examination, including examination of the thyroid gland, are otherwise unremarkable.
Laboratory studies show elevated plasma epinephrine and norepinephrine levels.
Abdominal CT scan reveals equivocal results.
Which of the following is the most appropriate next management step?
(A) Beta blockers
(B) Sestamibi scintigraphy
(C) Bilateral adrenal vein sampling
(D) Metaiodobenzylguanidine (MIBG) scan
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Old 06-01-2012
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(A) Beta blockers--treatment is alpha blockers. not beta

(B) Sestamibi scintigraphy--??for adrenals?? dont know

(C) Bilateral adrenal vein sampling -- done in conns syndrome for U/L adenoma

(D) Metaiodobenzylguanidine (MIBG) scan-- locates ectopic pheo.. for Rx. with removal
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Old 06-01-2012
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I will go with C to exclude undetectable pheo in the adrenal on CT "equivocal"
MIBG is the next step if sampling is negative
Sistamibi for parathyroid locating
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Old 06-01-2012
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(D) Metaiodobenzylguanidine (MIBG) scan

Diagnosis of a pheochromocytoma

Quote:
MIBG Scan

Additional studies that are available for localizing a pheochromocytoma include the MIBG scan and octreotide scan. MIBG scans is used to detect adrenal pheochromocytoma. This test does not detect any other type of adrenal tumor. This is a radioisotope study in which a substance that is required by the adrenal gland to manufacture adrenaline is labeled with a radioactive isotope. Tumor tissue, which makes large amounts of catecholamines, will selectively take up the radioactive labeled substance. This is then identified as hot spot under a machine that detects the radioisotope.
These data highlight why AVS should not be used in the investigation of adrenal pheochromocytoma

Quote:
: This report provides a reference range for adrenal vein catecholamine concentrations
in nonpheochromocytoma patients and illustrates the wide variation in epinephrine and norepinephrine concentrations. Epinephrine and norepinephrine concentrations are statistically significantly higher in the right vs. the left adrenal vein; in the case of epinephrine, up to an 83-fold
difference was found between the right and left adrenal veins.
Organ of Zuckerkandl

Quote:
The Organ of Zuckerkandl is of pathological significance in the adult as a common extra-adrenal site of pheochromocytoma though the most common extra-adrenal site is in the superior para-aortic region between the diaphragm and lower renal poles.

Last edited by Novobiocin; 06-01-2012 at 03:16 PM.
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Old 06-01-2012
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Quote:
Originally Posted by tyagee View Post
a 50-year-old man is evaluated for a recent onset recurrent episodes of palpitations, sweating, and headaches. Medical history is otherwise unremarkable. He takes no medications.
On physical examination, the patient appears anxious. Temperature is 37c, blood pressure is 168/96 mm hg, pulse rate is 88/min, respiration rate is 18/min, and bmi is 32.
Findings from a general physical examination, including examination of the thyroid gland, are otherwise unremarkable.
Laboratory studies show elevated plasma epinephrine and norepinephrine levels.
Abdominal ct scan reveals equivocal results.
Which of the following is the most appropriate next management step?
(a) beta blockers
(b) sestamibi scintigraphy
(c) bilateral adrenal vein sampling
(d) metaiodobenzylguanidine (mibg) scan
d..............
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  #6  
Old 06-02-2012
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yup, its MIBG scan. thank for all the replies...
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