A 25 year old young woman has recurrent episodes of headache and sweating. Her mother had renal calculi and died after having a neck mass. The physical examination reveals a thyroid nodule but no clinical sign of thyrotoxicosis. Before performing thyroid surgery, the surgeon should order -
Ans is option 4 It is a case of MEN type 2A i.e. Medullary Ca of thyroid, pheochromocytoma, hyperparathyroidism Before surgery of medullary Ca of thyroid these patients should be screened for pheochromocytoma Screening for pheochromocytoma consists of measurement of urinary free Catecholamines and its metabolites such as metanephrines and vanillyl mandelic acid. If not done then over production of Catecholamines by pheochromocytoma may cause swings in blood pressure and arrhythmia.. Ref Harrison 17/e p 2361 Love and Bailey 24/e p 802 819
Measurement of thyroid hormones
Serial detenriinations of serum calcium,phosphorus, protein and alkaline phosphatase
24-hours urine test for 5 hydroxyindoleacetic acid excretion
Serial 24 hours test for catecholamines, meta-nephrines and vanillylamandelic acid excretion
Endocrinology