Adrenal Disorders USMLE Step 1 Practice Question
A 32-year-old man with a history of multiple endocrine neoplasia type 1 (MEN-1) presents to the emergency department with a 2-month history of episodic severe headaches, profuse diaphoresis, and palpitations. Episodes occur unpredictably, 2-3 times weekly, and last 15-30 minutes. Vital signs show BP 178/108 mmHg, HR 116/min, RR 16/min, temperature 37.1°C. Physical examination reveals no orthostatic hypotension or focal neurologic deficits. A 24-hour urine collection shows elevated metanephrines at 420 nmol/24h (normal <100 nmol/24h). The patient has not taken any sympathomimetic medications or decongestants. Which of the following is the most appropriate next diagnostic step?
Answer choices
- AInitiate phentolamine infusion during an acute hypertensive episode to confirm diagnosis
- BPerform high-resolution CT imaging of the adrenal glands and abdomen
- CMeasure plasma free metanephrines after 30 minutes of supine rest in a quiet roomCorrect answer
- DProceed directly to surgical consultation for adrenalectomy based on biochemical confirmation
- EObtain a clonidine suppression test to differentiate pheochromocytoma from essential hypertension
- FPerform plasma normetanephrine-to-metanephrine ratio testing to exclude neuroblastoma
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