History:

A 45-year-old woman presents to the clinic with a 3-month history of intermittent episodes of headaches, palpitations, and excessive sweating. These episodes occur sporadically and last for about 20-30 minutes. The patient mentions feeling lightheaded and experiencing nausea during these episodes. The symptoms are often triggered by physical exertion or emotional stress.

The patient also notes unintentional weight loss of 5 kg over the past 2 months and occasional tremors. She has a history of hypertension, which has been difficult to control with multiple antihypertensive medications.

Medical History:

Hypertension for 4 years

No significant past surgical history

No family history of endocrine disorders

Non-smoker, moderate alcohol intake

Physical Examination:

Blood pressure: 180/100 mmHg, pulse: 110 bpm

Mild tremor in the hands

No signs of pallor or cyanosis

No palpable masses or signs of Cushingoid features

Investigations:

Urinary catecholamine levels: Elevated norepinephrine and metanephrines

Plasma free metanephrines: Significantly elevated

Abdominal CT scan: A mass is noted in the right adrenal gland, consistent with a pheochromocytoma

24-hour urine collection for vanillylmandelic acid (VMA): Elevated

Diagnosis:

Pheochromocytoma

Treatment Plan:

The patient is referred for surgery to remove the pheochromocytoma.

Alpha-blockers (phenoxybenzamine) are initiated to control hypertension and prevent a hypertensive crisis during surgery.

Post-operative follow-up for blood pressure management and potential adrenal insufficiency is planned.

Prognosis:

After successful removal of the tumor, the patient's symptoms are expected to resolve, and her blood pressure should become easier to manage.