The Journal of Emergency Medicine, Vol. -, No. -, p. 1, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter

http://dx.doi.org/10.1016/j.jemermed.2014.09.016

Visual Diagnosis in Emergency Medicine

YOUNG WOMAN WITH A HEADACHE Tichaendepi Mundangepfupfu, MD, MRes,* Dahlia Chalabi, MD,† and Muhammad Waseem, MD† *Transitional Year Department and †Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, New York Reprint Address: Tichaendepi Mundangepfupfu, MD, MRes, Transitional Year Department, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451

CASE REPORT A 26-year-old woman presented to the Emergency Department with a 1-week history of headaches. She stated that the light bothered her. She was 6 days post partum and had a history of hypertension and preeclampsia. She denied nausea, vomiting, a history of migraines, and drug abuse. On physical examination, she was afebrile, her blood pressure was 171/97 mm Hg, and her examination was otherwise unremarkable. A computed tomography scan of the abdomen and pelvis showed a left adrenal mass (Figure 1). The patient was admitted to confirm the diagnosis. Laboratory studies on urine revealed a normetanephrine level of 1791 mg/24 h and a total metanephrine level of 1719 mg/24 h.

Figure 1. Computed tomography scan showing a left adrenal, well-encapsulated triangular mass with heterogeneous arterial enhancement (arrows).

DISCUSSION

REFERENCES

Pheochromocytoma is a rare and potentially fatal catecholamine-secreting tumor (1). Hypertension and headaches are the most common symptoms in patients with pheochromocytoma (2). Establishing a diagnosis can be challenging, total urinary normetanephrine is the most sensitive laboratory test (1). Surgical removal is required for definitive cure, which is possible in the vast majority of cases (3).

1. Guller U, Turek J, Eubanks S, Delong ER, Oertli D, Feldman JM. Detecting pheochromocytoma: defining the most sensitive test. Ann Surg 2006;243:102–107. 2. Mittendorf EA, Evans DB, Lee JE, Perrier ND. Pheochromocytoma: advances in genetics, diagnosis, localization, and treatment. Hematol Oncol Clin North Am 2007;21:509–525. 3. Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 2001;134:315–329.

RECEIVED: 3 March 2014; FINAL SUBMISSION RECEIVED: 26 June 2014; ACCEPTED: 2 September 2014 1

Young woman with a headache.

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