Hou Runhua, Leathersich Ann M, Ruud Brenda Temke
Endocrine Unit, Department of Medicine, University of Rochester, Rochester, NY, 14642, USA.
J Med Case Rep. 2011 Jul 13;5:310. doi: 10.1186/1752-1947-5-310.
Pheochromocytoma is a rare cause of hypertension but it could have severe consequences if not recognized and treated appropriately. The association of pheochromocytoma and thrombosis is even rarer but significantly increases management complexity, morbidity and mortality. To the best of our knowledge, this is the first report of a patient with pheochromocytoma presenting with left axillary arterial and intracardiac thrombus.
A 47-year-old Caucasian woman with a past medical history of hypertension presented for medical attention with left arm numbness. Doppler ultrasound showed an obstructing thrombus in her left axillary artery. She had symptom resolution after stent placement in her left axillary artery. A subsequent echocardiogram demonstrated a large intracardiac mass and abdominal computed tomography revealed a 7 cm mass between her spleen and left kidney. Labile blood pressure was noted during admission and she had very high levels of plasma and 24-hour urine catecholamines and metanephrines tests. A (123)I- metaiodobenzylguanidine scan showed intense uptake in the left abdominal mass. After adequate alpha blockage with phenoxybenzamine, laparoscopic tumor resection was performed without complications. She had normal metanephrines and complete symptom resolution afterwards. The intracardiac mass also disappeared with anticoagulation. All other endocrine laboratory abnormalities returned to normal after surgery.
Arterial and ventricular thrombosis occurring in patients with pheochromocytoma is rare. A multi-disciplinary approach is necessary in caring for this type of patient. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of pheochromocytoma is the key to improving outcome.
嗜铬细胞瘤是高血压的罕见病因，但如果未得到正确识别和治疗，可能会产生严重后果。嗜铬细胞瘤与血栓形成的关联更为罕见，但会显著增加管理的复杂性、发病率和死亡率。据我们所知，这是首例患有嗜铬细胞瘤并伴有左腋动脉和心内血栓的患者报告。
一名47岁有高血压病史的白人女性因左臂麻木前来就医。多普勒超声显示其左腋动脉有阻塞性血栓。在左腋动脉置入支架后症状缓解。随后的超声心动图显示心内有一个大肿块，腹部计算机断层扫描显示脾脏和左肾之间有一个7厘米的肿块。入院期间发现血压不稳定，血浆和24小时尿儿茶酚胺及甲氧基肾上腺素检测水平非常高。碘（123）间碘苄胍扫描显示左腹部肿块有强烈摄取。在用苯苄胺进行充分的α受体阻滞之后，进行了腹腔镜肿瘤切除术，无并发症。之后她的甲氧基肾上腺素水平正常，症状完全缓解。抗凝治疗后心内肿块也消失了。术后所有其他内分泌实验室异常均恢复正常。
嗜铬细胞瘤患者发生动脉和心室血栓形成很罕见。对于这类患者，多学科方法是必要的。儿茶酚胺可能促成了我们这位患者血栓的形成。早期识别嗜铬细胞瘤是改善预后的关键。
