A 27-year-old man comes to the physician because of a 4-month history of recurrent episodes of headaches, palpitations, and sweating. He does not know his biological parents because he was adopted. His pulse is 103/min and blood pressure is 160/105 mm Hg. Physical examination shows multiple soft, yellow papules on the tip of the tongue. There is a 2-cm, firm thyroid nodule. The patient is also found to be positive for a germline RET mutation. A total thyroidectomy is planned. Prior to the surgery, additional testing should be performed to evaluate for an abnormality in which of the following organs?

Question

A 27-year-old man comes to the physician because of a 4-month history of recurrent episodes of headaches, palpitations, and sweating. He does not know his biological parents because he was adopted. His pulse is 103/min and blood pressure is 160/105 mm Hg. Physical examination shows multiple soft, yellow papules on the tip of the tongue. There is a 2-cm, firm thyroid nodule. The patient is also found to be positive for a germline RET mutation.  A total thyroidectomy is planned.  Prior to the surgery, additional testing should be performed to evaluate for an abnormality in which of the following organs?

Quizplus · Accepted Answer

Eductional Objective: Multiple endocrine neoplasia type 2 is caused by germline activating mutations in the RET proto-oncogene and frequently results in both medullary thyroid cancer and pheochromocytoma.  In patients with undiagnosed pheochromocytoma, induction of anesthesia (eg, preparation for thyroidectomy) can precipitate a catecholamine surge, leading to hypertensive crisis, flash pulmonary edema, and atrial fibrillation.

A 27-Year-Old Man Comes to the Physician Because of a 4-Month