Saxena N, Parry-Jones A J D
Department of Anaesthesia and Intensive Care, University Hospital of Wales, Heath Park, Cardiff CF14 4XR, UK.
Anaesthesia. 2008 Apr;63(4):428-32. doi: 10.1111/j.1365-2044.2007.05401.x.
Phaeochromocytomas can have a variety of presentations; however, traumatic haemorrhage into a phaeochromocytoma is a rare presentation. Diagnosing and managing a critically ill, septic patient with a phaeochromocytoma can be very challenging. We report a case of a 57-year-old man, with a previously undiagnosed phaeochromocytoma, who presented initially with bowel perforation following an assault. Following a laparotomy for bowel resection and anastomosis, whilst on the intensive care unit, he developed paroxysmal severe hypertension overlying septic shock. Phaeochromocytoma was confirmed using a computed tomography scan and urinary assay of metanephrines and catecholamines. We managed the haemodynamic instability using labetalol and noradrenaline infusions. As his septic state improved he was started on conventional therapy and following control of his symptoms over the next few weeks, he underwent an uncomplicated right sided adrenalectomy. He made a full recovery.
嗜铬细胞瘤可有多种表现形式；然而，嗜铬细胞瘤发生外伤性出血是一种罕见的表现。诊断和治疗一名患有嗜铬细胞瘤的重症脓毒症患者极具挑战性。我们报告一例57岁男性病例，其既往未诊断出嗜铬细胞瘤，最初因遭受袭击后出现肠穿孔而就诊。在接受剖腹肠切除吻合术后，入住重症监护病房期间，他在脓毒症休克基础上出现阵发性严重高血压。通过计算机断层扫描以及间甲肾上腺素和儿茶酚胺的尿液检测确诊为嗜铬细胞瘤。我们使用拉贝洛尔和去甲肾上腺素输注来处理血流动力学不稳定情况。随着他的脓毒症状态改善，开始给予常规治疗，在接下来几周症状得到控制后，他接受了一次无并发症的右侧肾上腺切除术。他完全康复。
