Renal Case: 47-year-old Woman with Palpitations

00:01 Let's move on to another clinical case.

00:03 We have a 47-year-old woman in a previous state of good health.

00:06 She presents to the emergency department with palpitations, diaphoresis, headache, and this impending sense of doom.

00:13 She doesn't take any prescribed medications other than ibuprofen occasionally and doesn't take illicit drugs.

00:18 Her physical exams are remarkable for a blood pressure of 190/100 mmHg, per pulse rate is 130/min, noted to be in sinus rhythm, and she has a mild tremor noted on exam and pallor of her skin.

00:32 On screening labs in the emergency department, they're remarkable for a normal CBC and chemistry's negative urine drug screen.

00:40 Provided this woman's hypertension is due to a secondary cause, what would the most likely etiology be and what is our next step in establishing a diagnosis? Let's go through the case and see if we've got some clues here.

00:54 Now, our patient is complaining of palpitations, diaphoresis, this impending sense of doom, these are all symptoms of catecholamine excess.

01:02 She's got hypertension, she's tachycardic, she has a mild tremor on exam, and she's pallored.

01:07 Again, these can be signs seen in catecholamine excess.

01:10 Importantly on our labs, she has a negative urine drug screen so the likelihood of her having a stimulant use causing catecholamine excess is less likely.

01:21 So, taken together, what is the most likely etiology causing this woman's symptoms and what's our next step in establishing a diagnosis? Probably a pheochromocytoma.

01:33 And the next step that we wanna do in terms of clinching the diagnosis would be a 24-hour urine for fractionated metanephrines and catecholamines.

01:40 We'll go over this in the next couple of slides and you'll understand why.