NMS Q&A Family Medicine

214 NMS Q&A Family Medicinelikelihoods would be small. Carcinoid syndrome is thesecond in consideration because it causes cataclysmicbouts, not unlike pheochromocytoma, and is generallytested for at the same time as pheochromocytoma. Thispatient did not exhibit hypertension in the office, ifpheochromocytoma were caused by epinephrine production,he could have normal blood pressures betweenattacks. Carcinoid is famous for causing flushing duringattacks but not hypertension. Thyrotoxicosis rarelyoccurs without sinus tachycardia or atrial fibrillation, asthe former is steady, not paroxysmal; the latter perhapsoccurs in bouts. For that matter, any type of supraventriculartachycardia is unlikely, given the regular rhythmfound at home by the spouse. Sepsis would be unlikely,given the basically well state in which the patient presentedto office the morning after an attack.ReferencesFamily Medicine Review . Kansas City , Missouri ; May 3–10;2009.Fitzpatrick PA . Endocrinology . In: Tierney LM , McPhee SJ ,Papadaki MA , eds. Medical Diagnosis and Treatment . 45th ed.Lange ; 2006 .McPhee SJ , Papadakis MA . Current Medical Diagnosis and Treatment2010 , 49th ed. New York/Chicago : McGraw-Hill/Lange ;2010 .Orth DN , Kovacs WJ . The adrenal cortex . In: Wilson , Foster ,Kronenberg , et al., eds. Williams Textbook of Endocrinology .9th ed. Philadelphia : WB Saunders ; 1998 :598–607.Sandarum V , Falko JM . Triage of problems of the adrenal gland .In: Rudy DR , Kurowski K , eds. Family Medicine: House OfficerSeries . Baltimore : Williams & Wilkins ; 1997 : 567 – 576 .