Erem Cihangir, Hacihasanoglu Arif, Cinel Akif, Isik A Cemal Umit, Reis Abdulkadir, Sari Ahmet, Ersoz Halil Onder, Ukinç Kubilay
Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Med Princ Pract. 2006;15(5):396-400. doi: 10.1159/000094277.
This is a report of 2 hypertensive siblings with a history of carotid body tumors and subsequent benign adrenal pheochromocytomas (pheos) in a family where the mother had died of possible adrenal carcinoma.
The first case was a 35-year-old woman with paroxysmal hypertensive attacks and a right adrenal mass. She had earlier undergone surgery to remove bilateral carotid body tumors. Investigation revealed excessive excretion of catecholamines and their metabolites in the urine. Abdominal MRI and (131)I-MIBG scintigraphy revealed a right adrenal tumor. Right adrenalectomy was performed. The second case, the 45-year-old brother of the first case, was found to have a left adrenal mass on abdominal MRI. Catecholamines and their metabolites in the urine were found to be increased. He had also had surgery to remove bilateral carotid body tumors of the neck. Left adrenalectomy was performed. Both siblings showed no evidence of other familial syndromes, such as multiple neoplasia type 2, von Hippel-Lindau disease or neurofibromatosis type 1.
Although the combination of familial carotid body tumors and pheo is rare, a patient who remains hypertensive after removal of a carotid body tumor deserves a careful evaluation to exclude pheo. Such tumors may be extra-adrenal or multifocal.
本文报告了一个家族中2名患有高血压的兄弟姐妹,他们有颈动脉体瘤病史,随后又出现了良性肾上腺嗜铬细胞瘤(嗜铬细胞瘤),其母亲可能死于肾上腺癌。
首例为一名35岁女性,有阵发性高血压发作及右侧肾上腺肿块。她早些时候接受了双侧颈动脉体瘤切除术。检查发现尿中儿茶酚胺及其代谢产物排泄过多。腹部MRI和(131)I-MIBG闪烁扫描显示右侧肾上腺肿瘤。遂行右侧肾上腺切除术。第二例是首例患者45岁的哥哥,腹部MRI发现左侧肾上腺肿块。尿中儿茶酚胺及其代谢产物增加。他也曾接受颈部双侧颈动脉体瘤切除术。遂行左侧肾上腺切除术。两名兄弟姐妹均未显示出其他家族综合征的迹象,如2型多发性肿瘤、冯·希佩尔-林道病或1型神经纤维瘤病。
虽然家族性颈动脉体瘤和嗜铬细胞瘤同时存在的情况罕见,但颈动脉体瘤切除后仍有高血压的患者应仔细评估以排除嗜铬细胞瘤。此类肿瘤可能为肾上腺外或多灶性。