Krakoff L R, Garbowit D
Department of Medicine, Mount Sinai Medical Center, New York, NY 10029-6574.
Clin Chem. 1991 Oct;37(10 Pt 2):1849-53.
Hypertension may be attributable to various disorders involving the central or peripheral adrenergic (catecholamine) pathways. Pheochromocytoma is the best known of these disorders, but many syndromes mimic the clinical features of this tumor. In adreno-medullary hypertension, cardiovascular tissues are stimulated by activation of alpha or beta adrenergic receptors, or both. Specific diagnosis of adreno-medullary hypertension depends on careful clinical assessment and selection of sensitive and specific biochemical tests for measuring the catecholamines and their principal metabolites in urine or plasma. If such tests indicate the presence of a chromaffin cell neoplasm, accurate localization (imaging) is provided by computed axial tomography (CAT) or magnetic resonance imaging (MRI). Adreno-medullary hypertension is effectively controlled, pharmacologically, by alpha and beta receptor antagonists, which may be given intravenously for emergencies. Excess catecholamine synthesis by pheochromocytomas can be reduced by methyltyrosine. Surgical cure of pheochromocytomas can be expected in most instances, but long-term surveillance for recurrent tumors, some of which may be malignant, is needed. Chemotherapy can reduce the tumor bulk of a malignant pheochromocytoma. Recent use of molecular biology techniques may be helpful in early detection of malignant transformation.
高血压可能归因于涉及中枢或外周肾上腺素能（儿茶酚胺）途径的各种疾病。嗜铬细胞瘤是这些疾病中最广为人知的，但许多综合征会模仿这种肿瘤的临床特征。在肾上腺髓质性高血压中，心血管组织通过α或β肾上腺素能受体的激活或两者同时激活而受到刺激。肾上腺髓质性高血压的特异性诊断取决于仔细的临床评估以及选择用于测量尿液或血浆中儿茶酚胺及其主要代谢产物的敏感且特异的生化检测方法。如果此类检测表明存在嗜铬细胞瘤，计算机断层扫描（CAT）或磁共振成像（MRI）可提供准确的定位（成像）。肾上腺髓质性高血压可通过α和β受体拮抗剂在药理学上得到有效控制，在紧急情况下可静脉给药。甲基酪氨酸可减少嗜铬细胞瘤过多的儿茶酚胺合成。在大多数情况下，嗜铬细胞瘤有望通过手术治愈，但需要对复发性肿瘤进行长期监测，其中一些可能是恶性的。化疗可缩小恶性嗜铬细胞瘤的肿瘤体积。最近分子生物学技术的应用可能有助于早期发现恶性转化。
