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T1 Age 25 36 22-year-old T2 Sex 37 42 woman T3 History 51 91 diagnosed in childhood with type IIb VHL T4 History 104 129 multiple retinal angiomas T5 History 131 147 pancreatic cysts T6 History 153 192 spinal and cerebellar hemangioblastomas T7 Clinical_event 202 210 admitted E1 Clinical_event:T7 T8 Nonbiological_location 218 226 hospital R1 MODIFY Arg1:T8 Arg2:E1 T9 Sign_symptom 254 261 dyspnea E2 Sign_symptom:T9 T10 Sign_symptom 266 278 palpitations E3 Sign_symptom:T10 T11 Detailed_description 242 253 progressive R2 MODIFY Arg1:T11 Arg2:E2 T12 Diagnostic_procedure 300 314 blood pressure E4 Diagnostic_procedure:T12 T13 Diagnostic_procedure 283 294 examination E5 Diagnostic_procedure:T13 T14 Lab_value 319 332 159/119 mm Hg R3 MODIFY Arg1:T14 Arg2:E4 T15 Diagnostic_procedure 341 346 pulse E6 Diagnostic_procedure:T15 T16 Lab_value 351 358 123 bpm R4 MODIFY Arg1:T16 Arg2:E6 T17 Diagnostic_procedure 360 380 Physical examination E7 Diagnostic_procedure:T17 R5 SUB_PROCEDURE Arg1:E4 Arg2:E5 R6 SUB_PROCEDURE Arg1:E6 Arg2:E5 T18 Sign_symptom 401 407 murmur E8 Sign_symptom:T18 T19 Detailed_description 392 400 systolic R7 MODIFY Arg1:T19 Arg2:E8 T20 Biological_structure 415 427 mitral focus T21 Biological_structure 433 458 irradiation to the axilla R8 MODIFY Arg1:T20 Arg2:E8 R9 MODIFY Arg1:T21 Arg2:E8 T22 Sign_symptom 463 478 pulmonary rales E9 Sign_symptom:T22 T23 Diagnostic_procedure 480 499 Electrocardiography E10 Diagnostic_procedure:T23 T24 Lab_value 509 531 no remarkable findings R10 MODIFY Arg1:T24 Arg2:E10 T25 Sign_symptom 550 561 tachycardia E11 Sign_symptom:T25 T26 Detailed_description 544 549 sinus R11 MODIFY Arg1:T26 Arg2:E11 T27 Diagnostic_procedure 563 579 Laboratory tests E12 Diagnostic_procedure:T27 T28 Diagnostic_procedure 610 639 pro-brain natriuretic peptide E13 Diagnostic_procedure:T28 T29 Detailed_description 599 609 N-terminal R12 MODIFY Arg1:T29 Arg2:E13 T30 Lab_value 590 598 elevated R13 MODIFY Arg1:T30 Arg2:E13 T31 Diagnostic_procedure 650 655 X-ray E14 Diagnostic_procedure:T31 R14 SUB_PROCEDURE Arg1:E13 Arg2:E12 T32 Biological_structure 644 649 chest R15 MODIFY Arg1:T32 Arg2:E14 T33 Sign_symptom 672 700 pulmonary interstitial edema E15 Sign_symptom:T33 T34 Clinical_event 718 726 admitted E16 Clinical_event:T34 T35 Biological_structure 734 758 Department of Cardiology R16 MODIFY Arg1:T35 Arg2:E16 T36 Disease_disorder 801 814 heart failure E17 Disease_disorder:T36 T37 Detailed_description 787 800 decompensated T38 Detailed_description 781 786 acute R17 MODIFY Arg1:T37 Arg2:E17 R18 MODIFY Arg1:T38 Arg2:E17 T39 Diagnostic_procedure 830 846 echocardiography E18 Diagnostic_procedure:T39 T40 Detailed_description 816 829 Transthoracic R19 MODIFY Arg1:T40 Arg2:E18 T41 Sign_symptom 856 863 dilated E19 Sign_symptom:T41 T42 Diagnostic_procedure 903 920 ejection fraction E20 Diagnostic_procedure:T42 T43 Lab_value 884 902 severely depressed R20 MODIFY Arg1:T43 Arg2:E20 T44 Sign_symptom 940 951 hypokinesia E21 Sign_symptom:T44 T45 Sign_symptom 963 983 mitral regurgitation E22 Sign_symptom:T45 T46 Severity 958 962 mild R21 MODIFY Arg1:T46 Arg2:E22 T47 Detailed_description 928 939 generalized R22 MODIFY Arg1:T47 Arg2:E21 T48 Sign_symptom 1059 1066 dyspnea E23 Sign_symptom:T48 T49 Detailed_description 1048 1058 paroxysmal R23 MODIFY Arg1:T49 Arg2:E23 T50 Detailed_description 1028 1044 several episodes R24 MODIFY Arg1:T50 Arg2:E23 T51 Medication 1090 1100 β-blockers E24 Medication:T51 T52 Medication 1105 1114 diuretics E25 Medication:T52 T53 Disease_disorder 1149 1170 adrenal gland disease E26 Disease_disorder:T53 A1 POLARITY E26 UNCERTAIN T54 Diagnostic_procedure 1188 1201 catecholamine E27 Diagnostic_procedure:T54 T55 Diagnostic_procedure 1206 1223 metanephrine test E28 Diagnostic_procedure:T55 T56 Biological_structure 1180 1187 urinary R25 MODIFY Arg1:T56 Arg2:E27 T57 Detailed_description 1172 1179 24-hour R26 MODIFY Arg1:T57 Arg2:E27 R27 MODIFY Arg1:T57 Arg2:E28 T58 Diagnostic_procedure 1249 1252 MRI E29 Diagnostic_procedure:T58 T59 Biological_structure 1241 1248 Cardiac R28 MODIFY Arg1:T59 Arg2:E29 T60 Diagnostic_procedure 1292 1312 cardiomyopathy study E30 Diagnostic_procedure:T60 R29 SUB_PROCEDURE Arg1:E29 Arg2:E30 T61 Sign_symptom 1423 1427 mass E31 Sign_symptom:T61 T62 Biological_structure 1412 1422 left renal R30 MODIFY Arg1:T62 Arg2:E31 T63 Detailed_description 1406 1411 great R31 MODIFY Arg1:T63 Arg2:E31 R32 MODIFY Arg1:T56 Arg2:E28 T64 Coreference 1447 1463 laboratory tests E32 Coreference:T64 R33 IDENTICAL Arg1:E32 Arg2:E28 R34 IDENTICAL Arg1:E32 Arg2:E27 T65 Diagnostic_procedure 1499 1513 norepinephrine E33 Diagnostic_procedure:T65 T66 Lab_value 1471 1488 markedly elevated T67 Diagnostic_procedure 1515 1535 total catecholamines E34 Diagnostic_procedure:T67 T68 Diagnostic_procedure 1537 1552 normetanephrine E35 Diagnostic_procedure:T68 T69 Diagnostic_procedure 1557 1569 metanephrine E36 Diagnostic_procedure:T69 T70 Diagnostic_procedure 1582 1593 epinephrine E37 Diagnostic_procedure:T70 R35 MODIFY Arg1:T66 Arg2:E33 R36 MODIFY Arg1:T66 Arg2:E34 R37 MODIFY Arg1:T66 Arg2:E35 R38 MODIFY Arg1:T66 Arg2:E36 R39 MODIFY Arg1:T66 Arg2:E37 T71 Lab_value 1625 1631 468 μg T72 Coreference 1610 1624 norepinephrine E38 Coreference:T72 T73 Coreference 1664 1675 epinephrine E39 Coreference:T73 T74 Coreference 1712 1732 total catecholamines E40 Coreference:T74 T75 Coreference 1773 1788 normetanephrine E41 Coreference:T75 T76 Coreference 1831 1849 total metanephrine E42 Coreference:T76 R40 IDENTICAL Arg1:E38 Arg2:E33 R41 IDENTICAL Arg1:E39 Arg2:E37 R42 IDENTICAL Arg1:E40 Arg2:E34 R43 IDENTICAL Arg1:E41 Arg2:E35 R44 IDENTICAL Arg1:E42 Arg2:E36 R45 MODIFY Arg1:T71 Arg2:E38 T77 Lab_value 1676 1681 13 μg R46 MODIFY Arg1:T77 Arg2:E39 T78 Lab_value 1733 1739 658 μg R47 MODIFY Arg1:T78 Arg2:E40 T79 Lab_value 1789 1797 2,988 μg R48 MODIFY Arg1:T79 Arg2:E41 T80 Lab_value 1850 1858 3,013 μg R49 MODIFY Arg1:T80 Arg2:E42 T81 Diagnostic_procedure 1908 1911 MRI E43 Diagnostic_procedure:T81 T82 Biological_structure 1898 1907 abdominal R50 MODIFY Arg1:T82 Arg2:E43 T83 Sign_symptom 1967 1973 masses E44 Sign_symptom:T83 T84 Detailed_description 1960 1966 cystic T85 Detailed_description 1956 1959 two R51 MODIFY Arg1:T84 Arg2:E44 R52 MODIFY Arg1:T85 Arg2:E44 T86 Biological_structure 1997 2015 left hypochondrium R53 MODIFY Arg1:T86 Arg2:E44 T87 Therapeutic_procedure 2026 2035 resection E45 Therapeutic_procedure:T87 T88 Coreference 2039 2050 both masses E46 Coreference:T88 R54 IDENTICAL Arg1:E46 Arg2:E44 T89 Detailed_description 2017 2025 Surgical R55 MODIFY Arg1:T89 Arg2:E45 T90 Therapeutic_procedure 2072 2082 α-blockade E47 Therapeutic_procedure:T90 T91 Therapeutic_procedure 2109 2119 β-blockade E48 Therapeutic_procedure:T91 T92 Medication 2088 2104 phenoxybenzamine E49 Medication:T92 T93 Medication 2125 2136 propranolol E50 Medication:T93 R56 SUB_PROCEDURE Arg1:E49 Arg2:E47 R57 SUB_PROCEDURE Arg1:E50 Arg2:E48 T94 Therapeutic_procedure 2148 2169 laparoscopic approach E51 Therapeutic_procedure:T94 R58 SUB_PROCEDURE Arg1:E51 Arg2:E45 T95 Disease_disorder 2199 2215 pheochromocytoma E52 Disease_disorder:T95 T96 Diagnostic_procedure 2250 2259 histology E53 Diagnostic_procedure:T96 T97 Therapeutic_procedure 2231 2246 renal carcinoma E54 Therapeutic_procedure:T97 T98 Detailed_description 2220 2230 clear cell R59 MODIFY Arg1:T98 Arg2:E54 T99 Clinical_event 2268 2277 follow-up E55 Clinical_event:T99 T100 Diagnostic_procedure 2279 2293 blood pressure E56 Diagnostic_procedure:T100 T101 Diagnostic_procedure 2298 2308 heart rate E57 Diagnostic_procedure:T101 T102 Lab_value 2316 2326 normalized R60 MODIFY Arg1:T102 Arg2:E56 R61 MODIFY Arg1:T102 Arg2:E57 T103 Lab_value 2328 2340 124/77 mm Hg R62 MODIFY Arg1:T103 Arg2:E56 T104 Lab_value 2342 2348 78 bpm R63 MODIFY Arg1:T104 Arg2:E57 T105 Diagnostic_procedure 2367 2380 catecholamine E58 Diagnostic_procedure:T105 T106 Biological_structure 2359 2366 urinary T107 Detailed_description 2351 2358 24-hour R64 MODIFY Arg1:T106 Arg2:E58 R65 MODIFY Arg1:T107 Arg2:E58 T108 Lab_value 2400 2412 normal range R66 MODIFY Arg1:T108 Arg2:E58 T109 Diagnostic_procedure 2414 2428 norepinephrine E59 Diagnostic_procedure:T109 T110 Lab_value 2429 2434 69 μg R67 MODIFY Arg1:T110 Arg2:E59 T111 Diagnostic_procedure 2441 2460 total catecholamine E60 Diagnostic_procedure:T111 T112 Lab_value 2461 2467 221 μg R68 MODIFY Arg1:T112 Arg2:E60 T113 Diagnostic_procedure 2474 2489 normetanephrine E61 Diagnostic_procedure:T113 T114 Lab_value 2490 2496 202 μg R69 MODIFY Arg1:T114 Arg2:E61 T115 Diagnostic_procedure 2506 2524 total metanephrine E62 Diagnostic_procedure:T115 T116 Lab_value 2525 2531 259 μg R70 MODIFY Arg1:T116 Arg2:E62 T117 Sign_symptom 2577 2589 palpitations E63 Sign_symptom:T117 A2 POLARITY E63 NEG T118 Sign_symptom 2593 2600 dyspnea E64 Sign_symptom:T118 A3 POLARITY E64 NEG R71 SUB_PROCEDURE Arg1:E59 Arg2:E58 R72 SUB_PROCEDURE Arg1:E60 Arg2:E58 R73 SUB_PROCEDURE Arg1:E61 Arg2:E58 R74 SUB_PROCEDURE Arg1:E62 Arg2:E58 T119 Date 2602 2618 Six months after E65 Date:T119 T120 Diagnostic_procedure 2639 2655 echocardiography E66 Diagnostic_procedure:T120 T121 Sign_symptom 2702 2718 normal diameters E67 Sign_symptom:T121 T122 Biological_structure 2682 2696 left ventricle R75 MODIFY Arg1:T122 Arg2:E67 T123 Biological_structure 864 878 left ventricle R76 MODIFY Arg1:T123 Arg2:E19 T124 Diagnostic_procedure 2733 2750 ejection fraction E68 Diagnostic_procedure:T124 T125 Lab_value 2723 2732 preserved R77 MODIFY Arg1:T125 Arg2:E68 T126 Diagnostic_procedure 2761 2777 Genetic analysis E69 Diagnostic_procedure:T126 T127 Sign_symptom 2789 2806 germline mutation E70 Sign_symptom:T127 T128 Detailed_description 2808 2823 exon 3 deletion T129 Detailed_description 2832 2857 VHL tumor suppressor gene T130 Detailed_description 2865 2890 short arm of chromosome 3 R78 MODIFY Arg1:T130 Arg2:T129 R79 MODIFY Arg1:T128 Arg2:T129 R80 MODIFY Arg1:T129 Arg2:E70 T131 Family_history 2911 2935 no family history of VHL T132 Detailed_description 2968 2984 de novo mutation R81 MODIFY Arg1:T132 Arg2:E70 * OVERLAP E1 E2 E3 E5 E7 E8 E9 E10 E11 E12 E14 E15 R82 BEFORE Arg1:E15 Arg2:E16 * OVERLAP E16 E17 E18 E19 E20 E21 E22 E23 E24 E25 E26 R83 BEFORE Arg1:E26 Arg2:E27 #1 AnnotatorNotes T57 Not a duration per se as it describes a diagnostic test * OVERLAP E28 E30 E31 E32 E33 E34 E35 E36 E37 E38 E39 E40 E41 E42 E43 E44 R84 BEFORE Arg1:E44 Arg2:E45 R85 AFTER Arg1:E45 Arg2:E47 * OVERLAP E47 E48 R86 BEFORE Arg1:E48 Arg2:E51 * OVERLAP E51 E52 E54 E53 R87 BEFORE Arg1:E53 Arg2:E55 * OVERLAP E55 E56 E57 E58 E63 E64 R88 BEFORE Arg1:E64 Arg2:E65 * OVERLAP E65 E66 E67 E68 E69 E70