Metanephrines for Evaluating Palpitations and Flushing.

A 29-year-old woman was referred for chronic paroxysmal palpitations, flushing, a pale complexion, and diaphoresis. She reported increasing symptoms possibly affected by stress, left lateral recumbent position, and physical activity. There was no history of weight loss, hypertension, medication use, or a family history of genetic syndromes such as von Hippel-Lindau. Physical examination revealed a body mass index of 25.9, blood pressure of 112/74 mm Hg, and a heart rate of 82 beats/min without cardiac or renal artery murmurs or skin lesions. Laboratory tests were performed (Table 1).