Approach to adrenal masses Quiz: Ace Your Exams

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A 54-year-old woman presents to the emergency department due to severe headache. Over the past few weeks, the patient has experienced intermittent, severe, pounding holocranial headaches. During these episodes, she has had increased sweating and a racing heartbeat. There is no associated chest pain, chest pressure or tightness, or shortness of breath. There is no significant past medical history, and the patient takes no medication. Family history is notable for Addison disease. Temperature is 37.7ºC (99.9ºF), pulse is 126/min, respiratory rate is 18/min, blood pressure is 203/116 mmHg, and SpO2 is 98% on room air. On physical examination, the patient appears uncomfortable, irritable, and diaphoretic. Cardiac exam reveals no murmurs, and the lungs are clear to auscultation. Which of the following is the best next step in management?

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Intravenous phentolamine

Adrenal vein sampling

Magnetic resonance imaging (MRI) of the abdomen

Intravenous hydrocortisone

Intravenous esmolol