The patient was diagnosed with a pheochromocytoma after a CT showed an adrenal nodule. The authors then ordered an MRI which showed the same. What do you want to bet a lot of this man's problems could have been avoided if someone had looked at his adrenals a long time ago? Excerpt from the article in "Endocrine Today" titled Pheochromocytoma imaging with an unremarkable biochemical evaluation:
The patient had an extensive history of CAD with myocardial infarctions complicated by arrhythmias at the ages of 30 and 57...
His medications included multiple antihypertensive agents including: Lisinopril 5 mg, Imdur 30 mg, Norvasc 10 mg, and Atenolol 50 mg. He was taking other medications including: Diazapam 10 mg, Metformin 500 mg, Protonix 40 mg, Avodart 0.5 mg, Crestor 10 mg and ASA 325 mg daily.
And now, the authors say the biochemical evidence is "unremarkable". Pheo's are notorious for being on again, off again. Hypertension is usually the main symptom of a pheo. This man's symptoms (partially listed in the excerpt above) read like a classic case of pheo. From reading the article, it looks like the limited biochemical testing was done over a short time span. Pheos typically present biochemically only sporadically, thus, rather than having "unremarkable" biochemical evidence, maybe the testing was "unremarkable". Just my two cents worth...
To read more:
Mayo
Merck
NIH
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