رجل عمره ٣٩ سنة تأتيه نوبات صداع شديد وخفقان وتعرق غزير وشحوب، وفي إحدى النوبات كان ضغطه ٢٣٠/١٣٠، وبين النوبات ضغطه طبيعي تقريباً. فقد وزناً قليلاً. ما الحالة التي يجب التفكير فيها؟

A 39-year-old has episodes of severe headache, palpitations, profuse sweating and pallor; during one episode BP was 230/130, with near-normal BP between attacks and slight weight loss. Which condition should be considered?

1. Panic attacks without an organic cause
2. Hyperparathyroidism
3. Phaeochromocytoma
4. Irritable bowel syndrome

Answer: C) Phaeochromocytoma. The triad of headache, palpitations and sweating with paroxysmal hypertension suggests a catecholamine-secreting adrenal tumour. Plasma or urine metanephrines are measured; before surgery alpha-blockade precedes beta-blockade.