Snapshot A 45-year-old woman presents to the emergency room from her primary care physician’s office for high blood pressure unresponsive to therapy. She has a history of neurofibromatosis type 1, though without any neurological deficits. She has multiple café-au-lait spots on her body. She is found to be hypertensive to 154/121 mmHg. Her 24-hour urine metanephrines and VMA come back elevated. Her abdominal CT comes back with an adrenal mass. Introduction Nonmalignant tumor of adrenal medulla login to view 3 more bullets Rule of 10’s login to view 6 more bullets Epidemiology 40-50 year old ETIOLOGY Pathogenesis login to view 1 more bullet Associated conditions login to view 4 more bullets Presentation Symptoms are episodic login to view 7 more bullets Physical exam login to view 2 more bullets Imaging Adrenal mass seen on MRI or CT MIBG scanning login to view 1 more bullet STUDIES Best initial test login to view 1 more bullet Confirmation with 24-hour urine collection login to view 2 more bullets Histology login to view 1 more bullet Differential Diagnosis Functional adrenal tumors login to view 10 more bullets Hyperthyroidism Carcinoid tumors Panic disorder Therapy resistant hypertension from obstructive sleep apnea Treatment In this sequence of events login to view 3 more bullets Complications Metastases login to view 1 more bullet Transformation to malignant tumor (10%) Hypertensive crisis Prognosis Very good with resection