A patient presents with an intermittent headache. On examination, there is hypertension and a thyroid nodule. Which of the following steps is to be taken next -
Intermittent headache (which is the most common symptom of Phaeochromocytoma) and thyroid Nodule points towards the occurrence of Phaeochromocytoma with Medullary Carcinoma Thyroid.


Pheochromocytoma together with medullary carcinoma of thyroid is a feature of MEN II syndrome.
They are associated with both MEN IIA and MEN IIB.

 

Diagnosis of phaeochromocytoma 


It is done by demonstrating excretion of catecholamine or catecholamine metobolites in urine.
The assays employed include those for


Vanillymandelic acid
Metanephrines


Unconjugated catecholamines or free Catecholamines.
For the diagnosis of Medullary Ca Thyroid aspiration is done of Thyroid Nodule.
Urine HIAA levels
Urine VMA and aspiration of the thyroid nodule
Ultrasound abdomen
Echocardiography