Int J Cardiol. 2011 Jan 21;146(2):e41-5. doi: 10.1016/j.ijcard.2008.12.183. Epub 2009 Feb 1.
A 66-year-old Japanese woman was urgently referred to our hospital. Two days prior to admission, her general practitioner began to administer prednisolone for treatment of a diagnosis of polymyalgia rheumatica. At the time of admission, laboratory results indicated multiorgan failure with rhabdomyolysis. Abdominal ultrasonography and computed tomography revealed a tumor in the right adrenal gland. On the same day, we measured serum and urine cathecholamines, which were markedly elevated. Additionally, magnetic resonance imaging revealed an adrenal mass and metaiodobenzylguanidine scintigraphy showed labeling of the tumor. Then, the patient underwent surgical resection of the tumor via laparoscopy. Histological examination confirmed the diagnosis of pheochromocytoma. One week after the operation, serum and urinary catecholamine levels returned to normal. The patient was discharged 10 days after the operation, and has remained stable at home. This report indicates that steroid should be avoided if possible in patients with pheochromocytoma. Furthermore, pheochromocytoma should be recalled as a differential diagnosis whenever patients take a sudden turn for the worse, or have acute uncontrollable hypertension following steroid administration and/or whenever patients present with unexplained rhabdomyolysis.
一位 66 岁的日本女性被紧急转至我院。在入院前两天，她的全科医生开始为多发性肌痛风湿症的诊断使用泼尼松龙进行治疗。入院时，实验室结果显示多器官衰竭伴有横纹肌溶解。腹部超声和计算机断层扫描显示右肾上腺有肿瘤。当天，我们检测了血清和尿液儿茶酚胺，结果明显升高。此外，磁共振成像显示肾上腺肿块，间碘苄胍闪烁扫描显示肿瘤有放射性标记。随后，患者通过腹腔镜进行了肿瘤切除术。组织学检查证实了嗜铬细胞瘤的诊断。术后一周，血清和尿儿茶酚胺水平恢复正常。术后 10 天，患者出院，在家中情况稳定。本报告表明，对于嗜铬细胞瘤患者，应尽可能避免使用类固醇。此外，每当患者在类固醇治疗后突然恶化，或出现急性无法控制的高血压，或出现不明原因的横纹肌溶解时，都应将嗜铬细胞瘤作为鉴别诊断。
