A 41 year old man was referred to the endocrine service at St Barts hospital. He had previously had a GP check-up and was found to be hypertensive, this led to him having an ultrasound KUB, an abnormality was detected which resulted in a CT abdomen being performed. The CT abdomen showed a 38×33 mm well defined right adrenal lesion and the patient was referred to endocrinology. Upon review, the patient had been having palpitations for the past year - particularly when straining on the lavatory but also unprovoked when resting - and episodes of sweating. The palpitations had provoked mutliple attendances to A+E and he had had a 24 hour Holter monitor, which was unremarkable. Examination was unremarkable aside from a blood pressure of 140/90, HR 100bpm on Verapamil. A 24 hour urinary metanephrine measurement was performed, which showed elevated 24 hr normetadrenaline of 11,544 nmol/day (normal <4,400) and 24 hr metadrenaline of 2,203 nmol/day (normal <2000). 3-Methoxytyramine levels were normal. Plasma calcitonin was subsequently found to be raised at 21 ng/l (normal <9.52). Gut hormones were within normal limits, but HbA1c was elevated at 45 mmol/mol. The patient was admitted for alpha blockade with phenoxybenzamine and IV fluid filling, he was subsequently beta blocked with propranolol. He also underwent an ultrasound of the thyroid, which showed some small nodules, but none were felt to display any worrying features. The patient is currently awaiting a right sided adrenalectomy.
16 - 18 Apr 2018
Society for Endocrinology