Hutchinson C D, Jardine D L, Hurrell M
Canterbury District Health Board, Christchurch, New Zealand.
Age Ageing. 2008 Sep;37(5):602-4. doi: 10.1093/ageing/afn105. Epub 2008 Jun 12.
We describe the case of a 75-year-old man presenting with labile hypertension and symptomatic postural hypotension 13 months following radiotherapy for squamous cell carcinoma of his external auditory canal. Magnetic resonance image (MRI) scan demonstrated scarring and a probable recurrence of his tumour. He underwent autonomic testing, including muscle sympathetic nerve activity (MSNA), heart rate (HR) and blood pressure (BP) responses to a variety of stimuli. Results were consistent with baroreflex failure. Urinary catecholamine levels were within the high normal range. We postulate that baroreflex failure was caused by vagal and glossopharyngeal nerve damage secondary to radiotherapy and tumour recurrence. This diagnosis is rare, but should be considered with pure autonomic failure and phaeochromocytoma in the presence of labile hypertension, especially in patients with a history of radiotherapy to the neck and high-normal catecholamine levels.
我们描述了一名75岁男性的病例，该患者在接受外耳道鳞状细胞癌放疗13个月后出现血压波动和症状性体位性低血压。磁共振成像（MRI）扫描显示有瘢痕形成，且肿瘤可能复发。他接受了自主神经功能测试，包括肌肉交感神经活动（MSNA）、心率（HR）和血压（BP）对各种刺激的反应。结果符合压力反射衰竭。尿儿茶酚胺水平在高正常范围内。我们推测压力反射衰竭是由放疗和肿瘤复发继发的迷走神经和舌咽神经损伤所致。这种诊断很罕见，但在存在血压波动的情况下，尤其是有颈部放疗史且儿茶酚胺水平高正常的患者，应与纯自主神经功能衰竭和嗜铬细胞瘤相鉴别。
