Marmouch Hela, Arfa Sondes, Graja Sameh, Slim Tensim, Khochtali Ines
Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Pan Afr Med J. 2016 Mar 10;23:75. doi: 10.11604/pamj.2016.23.75.8979. eCollection 2016.
A 52-year-old female with a history of poorly controlled resistant hypertension was admitted to our hospital with severe hypertension. She had a history of fatigue and intermittent episodes of palpitations. Laboratory evaluation was significant for elevated 24-h urinary catecholamine levels (3,5 times the upper normal levels). This case was presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. However, neither computed tomography nor meta-iodo-benzyl-guanidine scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. Our patient was screened with full polysomnography because of heavy snoring, daytime somnolence and obesity. It revealed severe obstructive sleep apnea syndrome. After three months of continuous positive airway pressure therapy, the patient experienced resolution of his presenting symptoms, improved blood pressure control and normalization of his urinary catecholamine levels. This case highlights sleep disordered breathing as a potentially reversible cause of pseudo-pheochromocytoma.
一名52岁女性，有难治性高血压且控制不佳的病史，因严重高血压入住我院。她有疲劳和间歇性心悸病史。实验室检查显示24小时尿儿茶酚胺水平升高（是正常上限的3.5倍）。该病例呈现出与嗜铬细胞瘤难以区分的临床和生化表现。然而，计算机断层扫描和间碘苄胍闪烁显像均未在肾上腺内外检测到任何产生儿茶酚胺的肿瘤。由于患者打鼾严重、白天嗜睡且肥胖，故对其进行了全面的多导睡眠图检查。结果显示为严重阻塞性睡眠呼吸暂停综合征。经过三个月的持续气道正压通气治疗，患者目前的症状得到缓解，血压控制得到改善，尿儿茶酚胺水平恢复正常。该病例突出了睡眠呼吸障碍作为假性嗜铬细胞瘤潜在可逆病因的情况。
