A patient presented with headache and episodes of hypertension. In between the episodes he was found to be normal. His urinary VMA levels were found to be raised. The diagnosis is
**Core Concept**
The patient's symptoms and elevated urinary VMA levels suggest a diagnosis related to catecholamine metabolism. VMA (Vanillylmandelic acid) is a metabolite of catecholamines, such as epinephrine and norepinephrine, which are produced by the adrenal glands. The patient's episodic hypertension and normal blood pressure between episodes indicate a condition characterized by intermittent catecholamine release.
**Why the Correct Answer is Right**
The elevated VMA levels indicate an overproduction of catecholamines, which is a hallmark of pheochromocytoma. This rare tumor of the adrenal gland causes excessive release of epinephrine and norepinephrine, leading to episodic hypertension, headaches, and other symptoms. The intermittent nature of the symptoms is due to the unpredictable release of catecholamines from the tumor. The normal blood pressure between episodes is a result of the episodic nature of the catecholamine release.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is likely a distractor as it does not directly relate to the patient's symptoms and elevated VMA levels. While thyroid disorders can cause hypertension, they do not typically present with episodic hypertension and elevated VMA levels.
**Option B:** This option is incorrect as it does not specifically address the patient's symptoms and elevated VMA levels. While certain medications can cause hypertension, they do not typically present with episodic hypertension and elevated VMA levels.
**Option C:** This option is incorrect as it does not accurately describe the patient's symptoms and elevated VMA levels. While certain conditions can cause episodic hypertension, they do not typically present with elevated VMA levels.
**Clinical Pearl / High-Yield Fact**
Elevated VMA levels are a key diagnostic clue for pheochromocytoma. Remember that pheochromocytomas can be bilateral, malignant, or part of a syndrome such as multiple endocrine neoplasia (MEN) type 2. Always consider pheochromocytoma in patients with episodic hypertension and elevated VMA levels.
**Correct Answer: C. Pheochromocytoma**