Petkou D, Petropoulos I K, Kordelou A, Katsimpris J M
Department of Ophthalmology, General Hospital of Patras 'O Agios Andreas', Patras, Greece.
Klin Monbl Augenheilkd. 2008 May;225(5):500-3. doi: 10.1055/s-2008-1027355.
We present a case of severe bilateral hypertensive retinopathy and optic neuropathy due to pheochromocytoma.
A 31-year-old woman presented with severe bilateral visual acuity loss associated with headaches and photophobia. Ophthalmoscopy showed bilateral optic disc edema, soft exudates, macular star, flame-shaped hemorrhages and arterial narrowing. The situation was more severe in the right eye. Fluorescein angiography confirmed the diagnosis of hypertensive retinopathy. Arterial blood pressure was 220/145 mmHg. A thorough systemic control revealed a right adrenal gland mass. Catecholamine secretion was normal. After ablation, the tumor proved to be a pheochromocytoma, and immunohistochemistry showed dopamine secretion.
Postoperative evolution was uncomplicated. Antihypertensive treatment lasted only a few months. Visual acuity was restored and the retinal alterations disappeared 8 months after surgery.
Severe hypertensive retinopathy with optic neuropathy may be a consequence of malignant hypertension due to a pheochromocytoma. It is reversible after ablation of the tumor. Early diagnosis is of vital importance and relies on hormonal investigation and immunohistochemistry.
我们报告一例因嗜铬细胞瘤导致的严重双侧高血压性视网膜病变和视神经病变。
一名31岁女性出现严重的双侧视力丧失，并伴有头痛和畏光症状。眼底检查显示双侧视盘水肿、软性渗出、黄斑星芒状渗出、火焰状出血和动脉狭窄。右眼情况更为严重。荧光素血管造影证实了高血压性视网膜病变的诊断。动脉血压为220/145 mmHg。全面的系统检查发现右侧肾上腺有肿块。儿茶酚胺分泌正常。切除后，肿瘤被证实为嗜铬细胞瘤，免疫组织化学显示有多巴胺分泌。
术后病情进展顺利。降压治疗仅持续了几个月。术后8个月视力恢复，视网膜病变消失。
严重的高血压性视网膜病变伴视神经病变可能是嗜铬细胞瘤所致恶性高血压的结果。肿瘤切除后可逆转。早期诊断至关重要，依赖于激素检查和免疫组织化学。
