Department of Internal Medicine, University of Pisa, Pisa, Italy.
Biomed Pharmacother. 2010 Sep;64(7):505-9. doi: 10.1016/j.biopha.2009.09.014. Epub 2009 Nov 17.
Phaeochromocytomas are rare neuroendocrine tumours secreting high levels of catecholamines, able to exert serious metabolic and cardiovascular effects. The serious and potentially lethal cardiovascular complications of these tumours are due to the potent effects of secreted catecholamines, especially noradrenaline, the main transmitter released from sympathetic nerve terminals. Hypertension, tachycardia, pallor, headache and anxiety, usually dominate the clinical presentation. Occasionally, patients with predominantly epinephrine-secreting tumours present hypotension or even shock. Other cardiovascular complications of pheochromocytoma include ischaemic heart disease, acute myocardial infarction, cardiac arrhythmias, heart failure due to toxic cardiomyopathy, or pulmonary edema. Catecholamines have been shown to influence the extracellular matrix with collagen deposition and subsequent fibrosis in the arterial wall and in the myocardium. These morphofunctional changes of the myocardium and of arterial wall can be emphasized by ultrasound imaging. Indeed, ultrasound imaging of the myocardium and arterial wall not only identifies wall thickness but also contains information on texture that may be revealed by acoustic tissue characterization. The latter can be quantified through videodensitometric analysis of echographic images or through ultrasonic integrated backscatter signal analysis. This paper reviews cardiovascular complications in patients with pheochromocytoma and utility of the new ultrasound technique as backscatter signal. It is useful for evaluating preclinical pathological morphofunctional changes of the myocardium and arterial wall, characterized by increased collagen content in pheochromocytoma patients. The recognition of early catecholamine-induced alterations in patients with pheochromocytoma, is important to prevent at least morbidity and mortality, before surgical treatment.
嗜铬细胞瘤是一种罕见的神经内分泌肿瘤，能分泌高水平的儿茶酚胺，对代谢和心血管系统产生严重影响。这些肿瘤的严重且潜在致命的心血管并发症是由于分泌的儿茶酚胺的强效作用引起的，尤其是去甲肾上腺素，它是从交感神经末梢释放的主要递质。高血压、心动过速、面色苍白、头痛和焦虑通常是主要的临床表现。偶尔，主要分泌肾上腺素的肿瘤患者会出现低血压甚至休克。嗜铬细胞瘤的其他心血管并发症包括缺血性心脏病、急性心肌梗死、心律失常、毒性心肌病引起的心衰或肺水肿。儿茶酚胺已被证明会影响细胞外基质，导致动脉壁和心肌中的胶原沉积和随后的纤维化。这些心肌和动脉壁的形态功能变化可以通过超声成像来强调。事实上，心肌和动脉壁的超声成像不仅可以识别壁厚度，还可以提供关于纹理的信息，这些信息可能通过声学组织特征化来揭示。后者可以通过超声图像的视频密度测量分析或通过超声背向散射信号分析来定量。本文综述了嗜铬细胞瘤患者的心血管并发症以及新型超声技术作为背向散射信号的应用。它有助于评估嗜铬细胞瘤患者心肌和动脉壁的临床前形态功能变化，这些变化的特征是胶原含量增加。在手术治疗前，识别嗜铬细胞瘤患者中早期儿茶酚胺诱导的改变对于预防至少是发病率和死亡率非常重要。
