Agarwal Amit, Gupta Sushil, Mishra Anand Kumar, Singh Nikhil, Mishra Saroj K
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226 014, India.
World J Surg. 2005 Sep;29(9):1185-8. doi: 10.1007/s00268-005-7839-4.
We report an audit of nine cases of subclinical or normotensive pheochromocytoma managed in our department. This is the first report from India of such a series. During the period 1990-2003 a total of 45 patients of pheochromocytoma were diagnosed and managed in the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences. Among them, nine patients were diagnosed as having subclinical or normotensive pheochromocytoma. Inclusion criteria for normotensive pheochromocytoma were: no previous history of hypertension clinically and, in the previous treatment documents, any episode of symptoms suggesting high blood pressure. The demographic profile, clinical presentation, biochemical investigations, imaging results, surgical notes, and follow-up record were reviewed retrospectively. All patients had a primary complaint of flank/abdominal pain and were normotensive. Seven had elevated urinary metanephrine levels, and one patient had normal values. One patient did not undergo the urinary metanephrine assay. Imaging of the abdomen showed seven adrenal and two extra-adrenal masses (eight had computed tomography scans of the abdomen, and one underwent ultrasonography). After selective alpha-adrenergic blockade (prazosin), surgery was performed. Six patients required infusion of sodium nitroprusside intraoperatively. The final histopathology was pheochromocytoma in all patients. Metanephrine levels were normal during the follow-up. Normotensive pheochromocytomas are a distinct entity, and all adrenal incidentalomas should be investigated for catecholamine hypersecretion. We support the use of preoperative alpha-adrenergic blockade, and these patients should be treated along the same lines as hypertensive pheochromocytoma.
我们报告了对本部门诊治的9例亚临床或血压正常的嗜铬细胞瘤病例的审计情况。这是印度关于此类病例系列的首份报告。1990年至2003年期间，在桑杰·甘地医学科学研究所内分泌外科共诊断并治疗了45例嗜铬细胞瘤患者。其中，9例被诊断为患有亚临床或血压正常的嗜铬细胞瘤。血压正常的嗜铬细胞瘤的纳入标准为：临床上既往无高血压病史，且在既往治疗记录中无任何提示高血压的症状发作。对患者的人口统计学资料、临床表现、生化检查、影像学结果、手术记录及随访记录进行了回顾性分析。所有患者的主要诉求均为胁腹/腹痛且血压正常。7例患者尿间甲肾上腺素水平升高，1例患者尿间甲肾上腺素水平正常。1例患者未进行尿间甲肾上腺素检测。腹部影像学检查显示7例肾上腺肿物和2例肾上腺外肿物（8例患者接受了腹部计算机断层扫描，1例接受了超声检查）。在进行选择性α-肾上腺素能阻滞剂（哌唑嗪）治疗后，实施了手术。6例患者术中需要输注硝普钠。所有患者的最终组织病理学检查结果均为嗜铬细胞瘤。随访期间间甲肾上腺素水平正常。血压正常的嗜铬细胞瘤是一种独特的疾病实体，所有肾上腺意外瘤均应进行儿茶酚胺分泌过多的检查。我们支持术前使用α-肾上腺素能阻滞剂，且这些患者应按照与高血压性嗜铬细胞瘤相同的方式进行治疗。
