Middle Aged Woman with Marfanoid Habitus, Neuromas and Diarrhea *

Your patient is a 45 year old female with marfanoid features and a history of neuromas. She comes to your clinic with a clinical history of a rapidly enlarging neck mass and hard fixed lymph nodes on the right side of the neck measuring up to 2.5 cm in diameter. She also complains of severe diarrhea and a 20 pound weight loss over the past two months. In addition she says that she has severe headaches and diaphoresis.

Her supine BP is 220/140 which drops to 150/100 when she stands up.

You would now order:

a. Exploratory Laparotomy

b. Open Neck Biopsy

c. Long term anti-hypertensive therapy

d. Laboratory tests including Catecholamines

e. Chest X-rays including Mediastinum

 *Note: Slides to this case were contributed by Viviana Acheen MD , Louisville, Ky

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