High Blood Pressures

 High Blood Pressures | Ommega Online Publishers


Case Stem (one to two paragraphs on pertinent patient and scenario information-this should be the stem for the learner and should include location, physician/help availability, family present, etc.)
60 year old male with no past medical or surgical history presented to the Emergency Room with sudden onset dyspnea and palpitations^[1,2]. For the past 2 weeks, he had been experiencing include intermittent headaches, palpitations, anxiety, and occasional shortness of breath on exertion, which is what brought him to the hospital. This morning, his wife noted increased anxiety leading to “he can’t catch his breath.” Work up includes an Electrocardiogram, cardiac enzymes, chest x-ray, stress test, and transthoracic echocardiography, all of which were normal. Incidentally, a abdominal Computerized tomography (CT) scan was performed, and an acute appendicitis could not be ruled out, so he was sent to the Operating Room to do a diagnostic laparoscopy and appendectomy. Background and briefing information for Facilitator/coordinator's eyes only In the ER, his blood pressure ranged from noninvasive systolic 140-280 millimeters mercury over diastolic 30-150 millimeters mercury, so a CT (computerized tomography) abdomen showed a 6-centimeter round mass retroperitoneally on the right adrenal gland suggesting pheochromocytoma[4,5], but this was missed initially as it only showed a possible acute appendicitis. Serum epinephrine was 18.6 nanogram/milliliter (normal: 0.01-0.18 nanogram/milliliter), norepinephrine 24.2 nanogram/milliliter (normal: 0.06-0.45 nanogram/milliliter), and dopamine 4.8 nanogram/milliliter (normal 0-0.09 nanogram/milliliter). No metaiodobenzylguanidine (MIGB) scan performed because of acute renal failure. 


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