A 55-year-old woman is evaluated for a 6-month history of recurrent episodes of palpitations, sweating, and headaches. Her medical history is unremarkable.
On physical examination: Patient appears anxious Temperature: 98.4°F Blood pressure: 158/96 mm Hg Pulse rate: 88/min Respiration rate: 18/min BMI: 30 Thyroid examination: Unremarkable Laboratory examination Epinephrine: 320 ng/L (1747 pmol/L) Norepinephrine: 1980 ng/L (11,704 pmol/L) Metanephrines: 124 pg/mL (12-61 pg/mL) Normetanephrines: 798 pg/mL (18-112 pg/mL) Thyroid-stimulating hormone: 1.2 µU/mL (1.2 mU/L) Urine Norepinephrine: 3215 µg/24 h (0-140 µg/24 h) Metanephrines: 575 µg/24 h (35-460 µg/24 h) Normetanephrines: 4350 µg/24 h (10-1050 µg/24 h) Vanillylmandelic acid: 12.3 mg/24 h (62.1 µmol/d) A CT scan of the adrenal glands shows no adrenal masses.
