Episodic hypertension is classical feature of
Ans. b (Pheochromocytoma) (Ref H-17th12270; Table 337-1)The dominant sign of Pheochromocytoma is hypertension. Classically, patients have episodic hypertension, but sustained hypertension is also frequent. These paroxysms generally last less than an hour and may be precipitated by surgery positional changes,exercise, pregnancy, urination (particularly bladder pheochromocytomas), and various medications (e.g., tricyclic antidepressants, opiates, metoclopramide).PHEOCHROMOCYTOMAClinical FeaturesThe clinical presentation is so variable that pheochromocytoma has been termed "the great masquerader". Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad.To enlist:HeadachesWeight lossSweating attacksParadoxical response to antihypertensive drugsPalpitation and tachycardiaPolyuria and polydipsiaHypertension, sustained or paroxysmalConstipationAnxiety and panic attacksOrthostatic hypotensionPallorDilated cardiomyopathyNauseaErythrocytosisAbdominal painElevated blood sugarWeaknessHypercalcemiaPheochromocytoma, DiagnosisDiagnostic MethodSensitivitySpecificity24-h urinary tests Vanillylmandelic acid++++++Catecholamines++++++Fractionated metanephrines++++++Total metanephrines+++++++Plasma Catecholamines+++++Free metanephrines+++++++Plasma Chromogranin A+++++CT+++++++MRI+++++++MIBG scintigraphy+++++++Somatostatin receptor scintigraphy++++Dopa (dopamine) PET (preliminary data)++++++++
Adrenal carcinoma
Pheochromocytoma
Conn's syndrome
Cushing's disease
C.V.S.