Martinez-Quintana Efren, Jaimes-Vivas Ricardo, Cuba-Herrera Javiel, Saiz-Udaeta Beatriz, Rodríguez-Gonzalez Fayna, Martinez-Martin Maria Soledad
Cardiology Service, Insular-Materno Infantil University Hospital, Las Palmas de Gran Canaria, Spain.
Int J Endocrinol Metab. 2013 Winter;11(1):48-51. doi: 10.5812/ijem.6562. Epub 2012 Dec 21.
Most pheochromocytomas are not suspected clinically while a high percentage of them are curable with surgery. We present the case of an adult cocaine-addicted male patient with an underlying pheochromocytoma and repeated myocardial infarctions. Computed tomography showed a left round adrenal mass, also high 24-hour urine levels of catecholamines and metanephrines were detected from urinalysis. The patient was given alpha and beta blockers, moreover a laparoscopic left adrenalectomy was performed. Cocaine can block the reuptake of noradrenaline, leading to increasing its concentration and consequently its effects as well, and induce local or diffuse coronary vasoconstriction in normal coronary artery segments per se, cocaine can also trigger pheochromocytoma crisis, and therefore, cardiac complications such as myocardial infarction due to these additive effects are intended to occur. For this reason, in the presence of typical clinical manifestations of pheochromocytoma, such as sustained or paroxysmal hypertension, headache, sweating, tachycardia and abdominal pain, probable association of this tumor in patients with cocaine abuse and associated cardiac complications must be ruled out.
大多数嗜铬细胞瘤在临床上未被怀疑，而其中很大一部分可通过手术治愈。我们报告一例成年男性可卡因成瘾患者，其患有潜在的嗜铬细胞瘤并反复发生心肌梗死。计算机断层扫描显示左肾上腺有一圆形肿块，尿液分析还检测到24小时尿儿茶酚胺和甲氧基肾上腺素水平升高。给予患者α和β受体阻滞剂，此外还进行了腹腔镜左肾上腺切除术。可卡因可阻断去甲肾上腺素的再摄取，导致其浓度升高，进而增强其作用，并且可卡因本身可在正常冠状动脉节段诱发局部或弥漫性冠状动脉收缩，还可引发嗜铬细胞瘤危象，因此，由于这些叠加效应导致心肌梗死等心脏并发症易于发生。因此，在存在嗜铬细胞瘤的典型临床表现，如持续性或阵发性高血压、头痛、出汗、心动过速和腹痛时，必须排除可卡因滥用患者中该肿瘤的可能关联以及相关的心脏并发症。
