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LydiaCombinedChart, Urinary Metabolites / Vanillylmandelic Acid (VMA) 24 hr - Positive - 120 micromol / 24 hr states and orders Urinary Catecholamines / Free - 1560 mmol / 24 hr, relates to normal pratice and experience submits Hypothesis 1 Pheochromocytoma - 100%, do consult plus order tests ahead states and orders CT / Body - Normal, reflecting on when and where to do imaging states discussing differential diagnosis, not used to these tests orders Aldosterone - 0.06-0.7 nmol/L (supine), 2-5 times supine value if upright, Thyroid Stimulating Hormone (TSH) - normal states and selects change working hypothesis: pheochromocytoma, these are the tests I was looking for orders Urinary Catecholamines / Norepinephrine - 89-591 nmol/day, belief change from75% to 38%, 65%, 62%, 59%, 60% states plan for testing: TSH and T4, eliminating possibility of drug abuse selects submitting Hypothesis Pheochromocytoma - 100%, not used to these tests orders Adrenocorticotropin homrone (ACTH) - 1.8-17.4 pmol/L (0800 hr) ; 1.5-6.6 pmol/L (1600 hr)