Pheochromocytoma: The Daily PANCE Blueprint
A 48-year-old woman presents to the clinic for a follow-up appointment. She has a history of hypertension managed with losartan, hydrochlorothiazide, and metoprolol. She reports episodes of palpitations, sweating, and severe headaches that occur sporadically and have been increasing in frequency over the past few months. Her blood pressure readings have been consistently elevated despite adherence to her medication regimen. She denies chest pain, shortness of breath, and any recent weight changes. On examination, her blood pressure is 160/100 mmHg, pulse is 110/min, and BMI is 23 kg/m². Routine lab work, including electrolytes, glucose, renal function, and TSH, is within normal limits. Which of the following is the most appropriate next step in the management of this patient?
A. Increase the dose of metoprolol
B. Measure 24-hour urinary cortisol levels
C. Measure plasma free metanephrines
D. Obtain renal ultrasound
E. Conduct a polysomnography
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ Hypertension ⇒ Secondary hypertension