Macrosson Duncan, Love Andrew
North Shore Hospital, Auckland, New Zealand.
BMJ Case Rep. 2017 Jan 18;2017:bcr2016218126. doi: 10.1136/bcr-2016-218126.
A 77-year-old man presenting to the emergency department with an acute coronary syndrome was later found to have a phaeochromocytoma. The lateness of this presentation was likely due to the protective α blocking effects of long-term terazosin therapy for his prostatism. α blockers such as terazosin are a well-recognised medical therapy in the perioperative optimisation of phaeochromocytoma because they treat the adrenergic effects of catecholamine release from the tumour such as hypertension. This patient was diagnosed with an ST elevation myocardial infarction (STEMI). A cardiac angiogram showed no evidence of vessel occlusion. A right adrenal mass of 9×8×9 cm was incidentally found and confirmed as a phaeochromocytoma with raised plasma metanephrines and normetanephrines. Following preoperative optimisation and multidisciplinary team involvement, an open right adrenalectomy was performed successfully some months later.
一名77岁男性因急性冠脉综合征就诊于急诊科，后来被发现患有嗜铬细胞瘤。此次就诊延迟可能是由于长期服用特拉唑嗪治疗前列腺增生症产生的保护性α受体阻滞作用。像特拉唑嗪这样的α受体阻滞剂在嗜铬细胞瘤围手术期优化治疗中是一种公认的药物治疗方法，因为它们可治疗肿瘤释放儿茶酚胺所产生的肾上腺素能效应，如高血压。该患者被诊断为ST段抬高型心肌梗死（STEMI）。心脏血管造影未显示血管闭塞迹象。偶然发现右侧肾上腺有一个9×8×9 cm的肿块，经检测血浆间甲肾上腺素和去甲间肾上腺素升高，确诊为嗜铬细胞瘤。经过术前优化并多学科团队参与后，数月后成功进行了开放性右侧肾上腺切除术。
