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A 45 year old male presented with palpitations, tachycardia & anxiety. His BP is 158/90 mmHg. The patient also has mild depression and is presently taking citalopram, labetalol & amlodipine to control his blood pressure. 24-hour urine total metanephrines are ordered and show an elevation of 1.5 times the upper limit of normal. What is the next best step?
Hold labetalol for 1 week and repeat testing
Hold citalopram for 1 week and repeat testing
Refer immediately for surgical evaluation
Measure 24-hour urine vanillylmandelic acid level
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