A patient presents with intermittent headache. On examination there is hypeension and a thyroid nodule. Which of the following steps is to be taken next :
Answer is B (Urine VMA and aspiration of the thyroid nodule) : Intermittent headache (most common symptom of Phaeochromocytoma) and presence of Thyroid Nodule point towards the occurrence of Phaeochromocytoma with Medullary Carcinoma Thyroid suggesting a diagnosis of MEN II syndrome. Next logical step to be taken is to confirm the provisional diagnosis and hence the following investigations are recommended. For diagnosis of phaeochromocytoma For diagnosis of Medullary Ca Thyroid Demonstrate excretion of Catecholamine metabolites in urine such as VMA, Metanephrine or free Catecholamines. Aspiration of thyroid nodule
Urine HIAA levels
Urine VMA and aspiration of the thyroid nodule
Ultrasound abdomen
Echocardiography