January 2005

Pheochromocytoma is a rare chromaffin cell neoplasm that secretes catecholamines and is usually found in the adrenal medulla. One fourth of these tumors are the result of genetic inheritance. Hypertension is the most common symptom. The classic triad of paroxysmal symptoms?consisting of palpitations, diaphoresis, and headaches?should prompt a consideration of this diagnosis and appropriate laboratory testing. The best biochemical marker is plasma free metanephrines, which is 99% sensitive and 89% specific for diagnosis. Magnetic resonance imaging and radioactive iodine metaiodobenzylguanidine scans are used to localize the tumor before surgery.

The last several years have witnessed a heightened interest in the metabolic syndrome, as it has become a health issue of epidemic proportions. Several metabolic abnormalities emerge as key players in the pathogenesis of the syndrome, including insulin resistance, obesity, and inflammation. Individuals with the metabolic syndrome are at increased risk for a variety of clinical conditions, some with serious health implications, particularly diabetes and cardiovascular disease. Treatment should address the causal mediators of the syndrome, such as obesity or insulin resistance. Lifestyle modification is one of the most successful treatments for the prevention of diabetes. Pharmacotherapy for dyslipidemia or hypertension can help prevent cardiovascular complications and the development of diabetes in those at risk.

Hydatid disease of the liver is endemic in some areas of the world but is rarely encountered in the United States. The disease is usually caused by the parasite Echinococcus granulosus. Physicians who work within multicultural communities must be aware of this disease and its treatment. We present the case of a 35-year-old Mexican woman who complained of chronic right upper-quadrant pain. Computed tomography scanning revealed a ring-enhancing lesion within the right lobe of the liver, suggesting the diagnosis of a hydatid cyst. Following a course of antiparasitic therapy, the cyst was surgically removed. Six months later, the patient was pain free.