Takeshita Yumie, Teramura Chisato, Takamura Toshinari
Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8640, Japan.
Endocr J. 2018 Dec 28;65(12):1155-1159. doi: 10.1507/endocrj.EJ18-0119. Epub 2018 Sep 8.
A 45-year-old male suddenly experienced left-flank abdominal pain. Echocardiography revealed akinesis of the 'takotsubo cardiomyopathy' type. He experienced a sudden haemodynamic collapse (blood pressure, 324/154 mmHg; pulse rate, 180 beats/min) during emergency cardiac catheterisation. An abdominal computed tomography (CT) revealed expansion of a soft tissue mass 64 × 33 mm in dimension in the left adrenal region, with accumulation of fluid surrounding the left pararenal space. Three days after the attack, his urinary catecholamine concentrations were slightly elevated. We suspected the patient as having a pheochromocytoma followed by acute haemorrhagic rupture, based on signatures of adrenal mass, 'takotsubo cardiomyopathy', and the hypertensive crisis. Over the next few weeks, he recovered well as an outpatient, and his blood pressure remained around 110/60 mmHg without medication. Three weeks after the attack, an abdominal CT showed shrinkage of the ruptured adrenal mass (to a diameter of 30 mm) and absorption of the retroperitoneal hematoma. On day 190 after the attack, abdominal CT did not detect any left adrenal mass. This is the first report of the case showing a complete vanishing of ruptured adrenal mass with takotsubo cardiomyopathy. Although surgical approaches for ruptured adrenal mass involve either emergency or elective surgery, the patients did not need even the elective surgery. Accumulation of the similar cases may unravel clinical factors predicting self-limiting of the ruptured adrenal mass to avoid unnecessary risky surgery.
一名45岁男性突然出现左腹侧腹痛。超声心动图显示为“应激性心肌病”类型的运动不能。他在紧急心脏导管插入术期间突然出现血流动力学崩溃（血压，324/154 mmHg；脉搏率，180次/分钟）。腹部计算机断层扫描（CT）显示左肾上腺区域有一个尺寸为64×33 mm的软组织肿块增大，左肾旁间隙周围有液体聚集。发作三天后，他的尿儿茶酚胺浓度略有升高。基于肾上腺肿块、“应激性心肌病”和高血压危象的特征，我们怀疑该患者患有嗜铬细胞瘤并伴有急性出血性破裂。在接下来的几周里，他作为门诊患者恢复良好，未用药时血压维持在110/60 mmHg左右。发作三周后，腹部CT显示破裂的肾上腺肿块缩小（直径为30 mm），腹膜后血肿吸收。发作190天后，腹部CT未检测到任何左肾上腺肿块。这是首例显示伴有应激性心肌病的破裂肾上腺肿块完全消失的病例报告。尽管针对破裂肾上腺肿块的手术方法包括急诊手术或择期手术，但该患者甚至不需要择期手术。积累类似病例可能会揭示预测破裂肾上腺肿块自限性的临床因素，以避免不必要的风险手术。
