MEDizzy - A 60-year-old man presents to the ED with severe headache

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Combined Surgery

A 60-year-old man presents to the ED with severe headache and diaphoresis that has been occurring intermittently for the previous 24 hours. He also notes occasional palpitations. The patient’s blood pressure is 220/110mm Hg, and he has papilledema on funduscopic examination. Intravenous phentolamine is effective at improving his blood pressure. Subsequent measurement of 24-hour urinary catecholamine metabolites yields increased values With which of the following neoplastic diseases is this patient’s cancer often associated?

ExplanationB. The patient has a pheochromo-cytoma, which is associated with multiple endocrine neoplasia (MEN) types 2A and 2B. MEN 2A includes medullary thyroid carcinoma, pheochromocytoma, and parathyroid hyperplasia. MEN 2B includes medullary thyroid carcinoma, pheochromocytoma, and mucosal/gastrointestinal neuromas. Other neoplastic diseases associated with pheochromocytoma include von Hippel- Lindau syndrome and neurofibromatosis. The gene implicated in MEN 2 syndrome is the RET proto-oncogene. Medullary carcinoma thyroid in MEN 2B syndrome has the worst prognosis. [remember: 2 = Second = Sipple] [remember 1 = Won = Wermer’s] MEN 1 = 3 P’s – Pituitary adenoma, parathyroid adenoma/ hyperplasia and pancreatic tumors.