Gill I S, Meraney A M, Bravo E L, Novick A C
Section of Laparoscopic and Minimally Invasive Surgery, and Departments of Urology and Nephrology/Hypertension, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2000 Aug;164(2):296-301.
Physiologically significant renal artery lesions in the presence of a pheochromocytoma comprise a confounding factor which may impact on the hypertension cure following excision of the pheochromocytoma. We present 10 cases of these dual lesions and review the literature on this entity.
From 1952 to 1999, 269 patients were diagnosed with pheochromocytoma at our institution. Hospital charts of these patients were reviewed retrospectively to identify those with coexisting renal artery stenosis. A Medline search was performed to review the available literature.
Of the 269 patients with pheochromocytoma 10 (3. 7%) had coexisting renal artery lesions, including renal artery stenosis in 8, renal artery aneurysm in 1 and postangiographic dissection occlusion in 1. Pheochromocytoma was adrenal in 8 cases and ectopic in 2. Of the patients 9 have been treated to date by adrenalectomy in 4, nephroadrenalectomy in 3, adrenalectomy plus lysis of renal artery adhesions in 1 and adrenalectomy plus renal autotransplantation with bench repair in 1. Both lesions were diagnosed preoperatively in 9 cases and a hypovascular adrenal lesion was missed preoperatively in 1. A review of literature revealed a total of 87 cases of coexisting pheochromocytoma and renal artery lesions.
There are multiple mechanisms that can lead to renal artery stenosis and pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively.
嗜铬细胞瘤患者存在具有生理意义的肾动脉病变是一个混杂因素，可能会影响嗜铬细胞瘤切除术后高血压的治愈情况。我们报告10例这类双重病变的病例，并回顾关于该实体的文献。
1952年至1999年，我院共诊断出269例嗜铬细胞瘤患者。对这些患者的医院病历进行回顾性分析，以确定那些同时存在肾动脉狭窄的患者。进行了Medline检索以回顾现有文献。
在269例嗜铬细胞瘤患者中，10例（3.7%）同时存在肾动脉病变，其中8例为肾动脉狭窄，1例为肾动脉瘤，1例为血管造影后夹层闭塞。嗜铬细胞瘤位于肾上腺的有8例，异位的有2例。在这些患者中，9例已接受治疗，其中4例行肾上腺切除术，3例行肾肾上腺切除术，1例行肾上腺切除术加肾动脉粘连松解术，1例行肾上腺切除术加肾自体移植并在体外修复。9例患者术前均诊断出两种病变，1例术前漏诊了肾上腺低血运病变。文献回顾显示，共有87例嗜铬细胞瘤与肾动脉病变并存的病例。
有多种机制可导致肾动脉狭窄和嗜铬细胞瘤。需要高度怀疑才能在术前诊断出这两种疾病，并允许对手术治疗进行适当规划。诊断不完整可能导致术后持续高血压。
