Shrikrishnapalasuriyar Natasha, Noyvirt Mirena, Evans Philip, Gibson Bethan, Foden Elin, Kalhan Atul
Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK.
Department of Intensive Care, Royal Glamorgan Hospital, Llantrisant, UK.
Endocrinol Diabetes Metab Case Rep. 2018 Apr 12;2018. doi: 10.1530/EDM-17-0170. eCollection 2018.
A 54-year-old woman was admitted to hospital with a presumed allergic reaction to a single dose of amoxicillin given for a suspected upper respiratory tract infection. She complained of chest tightness although there was no wheeze or stridor. On examination, she was pyrexial, tachycardic, hypertensive and had a diffuse mottled rash on her lower limbs. Her initial investigations showed raised inflammatory markers. She was treated in the intensive care for a presumed anaphylactic reaction with an underlying sepsis. Further investigations including CT head and CSF examination were unremarkable; however, a CT abdomen showed a 10 cm heterogeneous right adrenal mass. Based on review by the endocrine team, a diagnosis of pheochromocytoma crisis was made, which was subsequently confirmed on 24-h urinary metanephrine measurement. An emergency adrenalectomy was considered although she was deemed unfit for surgery. Despite intensive medical management, her conditioned deteriorated and she died secondary to multi-organ failure induced by pheochromocytoma crisis.
Pheochromocytoma have relatively higher prevalence in autopsy series (0.05-1%) suggestive of a diagnosis, which is often missed.Pheochromocytoma crisis is an endocrine emergency characterized by hemodynamic instability induced by surge of catecholamines often precipitated by trauma and medications (β blockers, general anesthetic agents, ephedrine and steroids).Pheochromocytoma crisis can mimic acute coronary syndrome, cardiogenic or septic shock.Livedo reticularis can be a rare although significant cutaneous marker of underlying pheochromocytoma crisis.
一名54岁女性因疑似上呼吸道感染接受单剂量阿莫西林治疗后出现疑似过敏反应而入院。她主诉胸部发紧，尽管没有喘息或喘鸣。检查时，她发热、心动过速、高血压，下肢有弥漫性斑点状皮疹。她的初步检查显示炎症标志物升高。她因疑似过敏反应合并潜在脓毒症在重症监护室接受治疗。包括头颅CT和脑脊液检查在内的进一步检查无异常；然而，腹部CT显示右侧肾上腺有一个10厘米的不均匀肿块。在内分泌团队会诊后，诊断为嗜铬细胞瘤危象，随后通过24小时尿间甲肾上腺素测定得到证实。尽管认为她不适合手术，但仍考虑进行急诊肾上腺切除术。尽管进行了强化治疗，她的病情仍恶化，最终因嗜铬细胞瘤危象导致多器官功能衰竭而死亡。
嗜铬细胞瘤在尸检系列中的患病率相对较高（0.05 - 1%），提示可能存在诊断，但往往被漏诊。嗜铬细胞瘤危象是一种内分泌急症，其特征是儿茶酚胺激增引起血流动力学不稳定，常由创伤和药物（β受体阻滞剂、全身麻醉剂、麻黄碱和类固醇）诱发。嗜铬细胞瘤危象可模拟急性冠状动脉综合征、心源性或感染性休克。网状青斑可能是潜在嗜铬细胞瘤危象罕见但重要的皮肤表现。
