Vandwalle J, Spie R, Jarry G, Agaesse V, Petit J, Saint F
Service d'urologie-transplantation, université Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, Salouel, 80054 Amiens cedex 1, France.
Prog Urol. 2010 Jul;20(7):498-502. doi: 10.1016/j.purol.2010.01.011. Epub 2010 Mar 12.
To identify cardiogenic failure or cardiogenic shock associated with pheochromocytoma diagnosis and emergency adrenalectomy. Update this unusual presentation of pheochromocytoma.
Between 1998 and 2009, 119 adrenalectomies were performed in our department, among which 19 cases for pheochromocytoma. We reported three cases with cardiogenic failure or cardiogenic shock associated with emergency adrenalectomy.
Patients were 36, 41 and 67 years old. The elapsed time between cardiogenic failure and surgery was 0, 7 and 19 days. The first diagnosis was a viral myocarditis in those three cases. The diagnosis of adrenal pheochromocytoma was done in a second step by the association of adrenal tumour on abdominal CT scan and detection of significantly elevated plasma/urine catecholamine. Severe systolic dysfunction with low ejection fraction was associated in all cases. Cardiac function was quickly restored after adrenalectomy.
Cardiac emergency associated with pheochromocytoma is an unusual clinical presentation. When diagnosis fails to be performed, patients have a very poor prognosis. According to a review of the sparse literature, only early recognition and emergency adrenalectomy can improve the outcome.
确定与嗜铬细胞瘤诊断及急诊肾上腺切除术相关的心源性衰竭或心源性休克。更新嗜铬细胞瘤这种不寻常的表现形式。
1998年至2009年期间，我科共进行了119例肾上腺切除术，其中19例为嗜铬细胞瘤。我们报告了3例与急诊肾上腺切除术相关的心源性衰竭或心源性休克病例。
患者年龄分别为36岁、41岁和67岁。心源性衰竭与手术之间的间隔时间分别为0天、7天和19天。这3例患者最初均诊断为病毒性心肌炎。通过腹部CT扫描发现肾上腺肿瘤并检测到血浆/尿儿茶酚胺显著升高，第二步确诊为肾上腺嗜铬细胞瘤。所有病例均伴有严重的收缩功能障碍及低射血分数。肾上腺切除术后心脏功能迅速恢复。
与嗜铬细胞瘤相关的心脏急症是一种不寻常的临床表现。若未能做出诊断，患者预后极差。根据对少量文献的回顾，只有早期识别并进行急诊肾上腺切除术才能改善预后。
