La Batide-Alanore Agnès, Chatellier Gilles, Plouin Pierre-François
Hypertension Unit, Hôpital Européen Georges Pompidou, Paris, France.
J Hypertens. 2003 Sep;21(9):1703-7. doi: 10.1097/00004872-200309000-00020.
To assess the prevalence of diabetes in patients with pheochromocytoma and the probability of pheochromocytoma occurring in hypertensive patients with or without diabetes.
A tertiary, referral hypertension department.
We compared age, body mass index and the frequency of diabetes in 191 patients with pheochromocytoma and a random sample of 880 patients with essential hypertension. Diabetes was defined as current antihyperglycemic treatment or two fasting blood glucose concentrations >or= 7 mmol/l. For patients with pheochromocytoma, we also recorded plasma catecholamine concentrations, the urinary excretion of metanephrines, and tumor characteristics.
Diabetes was present in 68 (35.6%) patients with pheochromocytoma and 192 (21.8%) patients with essential hypertension (P < 0.001). Pheochromocytoma patients with or without diabetes did not differ in body mass index, plasma noradrenaline concentration, metanephrine excretion or tumor characteristics. Age, duration of hypertension and plasma adrenaline concentration were significantly and independently associated with diabetes in patients with pheochromocytoma. They were younger, more likely to be female and had a lower body mass index than those with essential hypertension (P < 0.01). After adjustment for these three variables, the odds ratio for pheochromocytoma in hypertensive patients with diabetes was 5.5 (95% confidence interval, 3.5-8.7). For patients younger than the age of 51 years with a body mass index < 25 kg/m2, the odds ratio was 18.9 (95% confidence interval, 5.9-58.8).
Diabetes is present in one in three patients with pheochromocytoma. In young patients with hypertension and normal body weight, the presence of diabetes is a clinical clue to the diagnosis of pheochromocytoma.
评估嗜铬细胞瘤患者中糖尿病的患病率，以及糖尿病患者或非糖尿病高血压患者发生嗜铬细胞瘤的概率。
一家三级转诊高血压科室。
我们比较了191例嗜铬细胞瘤患者与880例原发性高血压患者的随机样本的年龄、体重指数及糖尿病发生率。糖尿病定义为正在接受降糖治疗或两次空腹血糖浓度≥7 mmol/l。对于嗜铬细胞瘤患者，我们还记录了血浆儿茶酚胺浓度、间甲肾上腺素的尿排泄量及肿瘤特征。
68例（35.6%）嗜铬细胞瘤患者及192例（21.8%）原发性高血压患者患有糖尿病（P<0.001）。有或无糖尿病的嗜铬细胞瘤患者在体重指数、血浆去甲肾上腺素浓度、间甲肾上腺素排泄量或肿瘤特征方面无差异。在嗜铬细胞瘤患者中，年龄、高血压病程及血浆肾上腺素浓度与糖尿病显著且独立相关。他们比原发性高血压患者更年轻，女性更多见，体重指数更低（P<0.01）。对这三个变量进行校正后，糖尿病高血压患者发生嗜铬细胞瘤的比值比为5.5（95%置信区间为3.5-8.7）。对于年龄小于51岁且体重指数<25 kg/m²的患者，比值比为18.9（95%置信区间为5.9-58.8）。
三分之一的嗜铬细胞瘤患者患有糖尿病。在年轻、高血压且体重正常的患者中，糖尿病的存在是诊断嗜铬细胞瘤的临床线索。
