Pheochromocytoma

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

A 38-year-old woman from Mumbai presents with episodic severe headaches, profuse diaphoresis, and palpitations for 3 months. Her blood pressure during an episode was 180/110 mmHg, and between episodes it normalizes to 130/80 mmHg. She reports anxiety during attacks and occasional chest pain. Urine metanephrines are elevated at 1.8 times the upper limit of normal. CT abdomen shows a 3 cm left adrenal mass. She has no family history of hypertension or endocrine tumors. What is the most appropriate next step in management?

A 52-year-old man from Delhi with a 10-year history of hypertension presents to the emergency department with acute-onset severe headache, chest pain, and sweating. His blood pressure is 210/130 mmHg, heart rate 115 bpm, and ECG shows ST-segment depression in leads V2–V4. Serum troponin I is 0.8 ng/mL (elevated). Plasma free metanephrines are markedly elevated (norepinephrine 4.2 nmol/L, normal <0.9). Abdominal CT reveals a 4 cm right adrenal mass. What is the most likely explanation for his acute coronary syndrome presentation?

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?