Pheochromocytoma

Which of the following is the most sensitive biochemical test for diagnosis of pheochromocytoma?

A 38-year-old man presents with episodic headaches, profuse sweating, and palpitations for 3 months. Blood pressure is 165/105 mmHg at rest. Clinical suspicion for pheochromocytoma is high. Which investigation is the most appropriate initial confirmatory test?

A 45-year-old woman with confirmed pheochromocytoma (elevated plasma metanephrines) has a 2 cm mass on CT abdomen. To exclude extra-adrenal pheochromocytoma (paraganglioma) and assess for metastatic disease before surgery, which is the most appropriate next investigation?

Which of the following genetic syndromes is associated with the HIGHEST risk of bilateral pheochromocytoma?

A 42-year-old man with a family history of medullary thyroid carcinoma presents to the emergency department with acute severe headache, chest tightness, and blood pressure 210/130 mmHg. His 24-hour urine metanephrines are markedly elevated at 8.5 nmol/L. Abdominal imaging reveals bilateral adrenal masses (2.5 cm left, 1.8 cm right). Serum calcium is 10.2 mg/dL (normal 8.5–10.5). What is the most likely underlying genetic syndrome, and what is the recommended screening for this patient's first-degree relatives?