A 32- year-old accountant, Mr PT, went to the Occupational Health Department at his workplace as he had been experiencing headaches and palpitations for the last few months. These had become increasingly frequent and his colleagues had noticed that he became extremely pale at the times he complained of palpitations. At the time of these episodes he had a bizarre sensation of extreme anxiety and fear of death. There was nothing to find on examination apart from an elevated blood pressure of 180/105. There was no significant family history.

The occupational health physician was sufficiently concerned to refer him to the local Endocrine Department. Investigations there revealed elevated levels of plasma and urine metanephrines. Abdominal MRI scans and radioisotope scanning using iodine-labelled meta-iodobenzyl guanidine (MIBG) demonstrated a 5 × 6 cm mass in the region of the right adrenal gland consistent with a phaeochromocytoma. He was treated with the α-adrenoceptor-blocking drug phenoxybenzamine with the later addition of the β-blocker pro- pranolol prior to surgery 6 weeks later. At operation the phaeochromocytoma was removed and he made an uneventful recovery.