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Case (4)


Mr Othman Ali is a 40-year-old airline pilot who, 15 years before, had initially trained as a fighter pilot.
 He is being seen because he has had several 'odd episodes' over a period of three weeks. He describes attacks,
 each one lasting approximately twenty minutes, where he develops severe headaches, thumping of his heart,
 sweating, nausea, tremor and feeling faint. His past medical history includes a parathyroid gland adenoma
which was removed surgically 10 years previously.

On examination, the only positive finding is hypertension: BP= 180/100.
1 What is the likely diagnosis?

2 How would you confirm the diagnosis?

3 What is the significance of the patient's previous parathyroid  adenoma?
Who answer all these above questions correctly will be a warded 15 points immediately
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By: Dr.Mahdi 

The 15 point of this case goes to Mustafa, who answered it correctly and this was his answer:

1. My first differential diagnosis would be pheochromocytosis. The classic triad of symptoms in patients with a pheochromocytoma consists of episodic headache, sweating, and tachycardia if the parathyroidectomy initially is not taken into consideration
2. The diagnosis is typically confirmed by measurements of a single 24-h urine sample and plasma fractionated metanephrines and catecholamines, provided the patient is hypertensive or symptomatic at the time of collection.
3. parathyroid hyperplasia or adenoma in the medical history of our patient might suggest MEN ( Multiple Endocrine Neoplasia ) type 2A.
explanation: most likely  subvarient type of  MEN2A
1.Pheochromocytoma (usually bilateral and may be asynchronous) occurs in 50% of patients with MEN2A
2. Hyperparathyroidism ( due to occurs in 15 to 20% of patients, with the peak incidence in
the third or fourth decade
3. Medullary carcinoma of the thyroid (MTC ), usually occurs in childhood.
Thanks Dr.Mustafa


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