A 62-year-old retired machinist, known for his elaborate Christmas decorations, comes
to the emergency department after several weeks of unexplained flushing, pounding
palpitations, and watery diarrhea. His wife reports that in certain lighting - especially
when he is standing in front of the Christmas tree - his face and hands look greenish.
He has lost 5 pounds of weight since the onset of his symptoms. He states that his
flushing began the day after Thanksgiving and that the episodes have become more frequent,
now occurring nightly. He denies any recent travel, exposure to illness, or change
in his medications. He notes, however, that he has switched to a "festive herbal tea
blend" which he drinks four or five times a day during the holidays.
Pertinent findings on physical examination include a normal temperature, a heart rate
of 108 beats per minute, mild postural hypotension (BP changes from 134/80 sitting
to 102/68 mmHg standing), and a respiratory rate of 14 breaths per minute. His skin
is warm, dry, and exhibits a faint flushing. The remainder the examination is within
normal limits.
What is your diagnosis, what test(s) would your order to confirm your suspicions,
and what treatment, if any, do you recommend?
In order to receive credit, please email your answers to smithj@etsu.edu.