Wordsworth Simon, Thomas Ben, Agarwal Neera, Hoddell Kate, Davies Steve
Department of Diabetes & Endocrinology, University Hospital Of Wales, Heath Park, Cardiff, UK.
BMJ Case Rep. 2010 Dec 29;2010:bcr0120102612. doi: 10.1136/bcr.01.2010.2612.
A 51-year-old woman was admitted with left-sided flank pain initially thought to be renal colic. However, a CT urogram was normal. During the course of the admission the pain persisted and she developed severe sustained hypertension. A repeat CT scan of the abdomen revealed a 5×3 cm left adrenal abnormality consistent with haemorrhage, not seen on the original scan. Further assessment revealed elevated urine catecholamines and a short synacthen test showed a suboptimal cortisol response. The diagnosis was initially considered as a phaeochromocytoma, she received phenoxybenzamine with good resolution of hypertension and was referred for surgical opinion. However, serial urinary catecholamine concentrations returned to within the normal range and the diagnosis was revised to adrenal infarction and haemorrhage due to antiphospholipid syndrome. This case illustrates the importance of recognising adrenal infarction as a potential cause of 'pseudophaeochromocytoma'.
一名51岁女性因左侧胁腹疼痛入院，最初被认为是肾绞痛。然而，CT尿路造影结果正常。在住院期间，疼痛持续存在，她出现了严重的持续性高血压。再次进行腹部CT扫描显示左肾上腺有一个5×3厘米的异常，符合出血表现，最初的扫描未发现。进一步评估显示尿儿茶酚胺升高，短程促肾上腺皮质激素试验显示皮质醇反应欠佳。最初诊断考虑为嗜铬细胞瘤，她接受了酚苄明治疗，高血压得到明显缓解，并被转诊以寻求手术意见。然而，系列尿儿茶酚胺浓度恢复到正常范围内，诊断被修订为抗磷脂综合征所致的肾上腺梗死和出血。该病例说明了认识到肾上腺梗死是“假性嗜铬细胞瘤”潜在病因的重要性。
