This case involves a twenty-eight-year-old female who presented to an urgent care center with complaints of a headache, sweating, and heart palpitations. She also noted that she had experienced anxiety during the previous months. The woman’s blood pressure was recorded to be 210/90 mmHg at the urgent care center. Her past medical history included thyroid cancer and primary hyperparathyroidism, which were both treated successfully prior to the plaintiff’s presentation to the urgent care center. She was started on metoprolol and lisinopril to help control her blood pressure. Once stabilized, the woman was discharged and recommended to establish care with a primary care physician. Three months later, she visited her primary care physician with similar complaints. Given her symptoms and past medical history, the physician wanted to do further testing. Laboratory testing revealed that she had elevated catecholamine levels. A CT scan of her abdomen showed that she had a left-sided adrenal tumor which was confirmed to be a pheochromocytoma. Genetic studies were also ordered, which showed a mutation consistent with multiple endocrine neoplasia type 2B (MEN 2B). The diagnosis of MEN 2B explained the constellation of medical conditions she had encountered throughout her lifetime. She was immediately scheduled for resection of the pheochromocytoma. After surgery, she required care with a cardiologist to address the cardiac damage that had developed.
Question(s) For Expert Witness
- 1. Did this urgent care center properly work up this woman’s medical condition, and what could have been done to diagnose and treat this patient properly?
Expert Witness Response
The urgent care center, in this case, treated the woman’s hypertension without further investigating its cause. This patient had a significant medical history that was associated with her hypertension. This should have clued the physician into the possibility of a multiple endocrine neoplasia. This woman had MEN 2B, a triad of medullary carcinoma of the thyroid, hyperparathyroidism, and pheochromocytoma. Due to the delay in diagnosis, this woman suffered cardiac damage. The urgent care center should have performed the proper testing that her primary care physician ordered. If that testing was unavailable, they should have referred her to someone who could. Pheochromocytoma is a catecholamine-secreting tumor that causes individuals to experience a classic triad of a headache, tachycardia, and sweating. Other signs and symptoms of pheochromocytoma include flank pain, hypertension, anxiety, pallor, and weight loss. Hypertension is a serious concern with these patients because it can affect cardiac functioning.