Marek J, Kopecká J, Musilová J, Horký K, Petrásek J
Cas Lek Cesk. 1989 Jul 14;128(29):907-14.
Pheochromocytoma is still a dangerous disease which is often difficult to diagnose. Evidence of the wide spectrum of its clinical picture was found in a group of 13 patients who were examined in the last 5 years. Drawing on their experience, the authors evolved a scheme of diagnostic examination. The primary biochemical examination involves the determination of urinary excretion of free catecholamines adrenaline, noradrenaline and dopamine simultaneously with their methylated metabolites metanephrine and normetanephrine, which help to make a more exact diagnosis in cases where the results of free catecholamines are not clear. Patients with pheochromocytoma lack diurnal rhythm of catecholamine excretion and thus the collection is made twice - by day and night. The determination of plasma catecholamines provides additional information. Only half the patients were found to have the level of vanillylmandelic acid increased. A significantly increased dopamine excretion points to the malignant form of the disease. The localization is established with the aid of computed tomography and, if needed, also by the determination of plasma catecholamines through selective cavae sampling. The final step serving to verify the diagnosis involves analysis of catecholamines in tumour tissue.
嗜铬细胞瘤仍然是一种危险的疾病，常常难以诊断。在过去5年里接受检查的一组13例患者中发现了其临床表现广泛多样的证据。根据他们的经验，作者制定了一套诊断检查方案。初步生化检查包括同时测定尿中游离儿茶酚胺肾上腺素、去甲肾上腺素和多巴胺及其甲基化代谢产物间甲肾上腺素和去甲间甲肾上腺素，这有助于在游离儿茶酚胺结果不明确的情况下做出更准确的诊断。嗜铬细胞瘤患者缺乏儿茶酚胺排泄的昼夜节律，因此要分昼夜两次收集尿液。血浆儿茶酚胺的测定可提供更多信息。仅发现一半患者香草扁桃酸水平升高。多巴胺排泄显著增加表明疾病为恶性形式。借助计算机断层扫描进行定位，如有需要，还可通过选择性腔静脉采样测定血浆儿茶酚胺来定位。用于验证诊断的最后一步是分析肿瘤组织中的儿茶酚胺。
