Department of Radiology, University of California, San Francisco, CA, USA.
Int Braz J Urol. 2011 Jan-Feb;37(1):35-40;discussion 40-1. doi: 10.1590/s1677-55382011000100005.
To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma.
Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation.
None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct.
Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.
报告在接受意外嗜铬细胞瘤切除术的患者中发生儿茶酚胺危象的风险。
在四年期间，我们回顾性地确定了 4 名患者，他们在接受肾上腺嗜铬细胞瘤切除术时，术前临床、生化和影像学评估均未提示嗜铬细胞瘤。
无患者出现术前儿茶酚胺过多的临床特征。2 名患者的术前生化筛查均正常。所有患者的 CT 扫描均显示为非特异性增强肾上腺肿块。在切除肾上腺肿块的过程中，有 2 名患者出现血流动力学不稳定，其中 1 名患者还发生了心肌梗死。
外科医生和放射科医生都应高度怀疑嗜铬细胞瘤，因为肿瘤可能无症状、生化检查正常且影像学特征不典型。切除这些意外嗜铬细胞瘤会显著增加术中血流动力学不稳定的风险。
