Oishi S, Sasaki M, Ohno M, Umeda T, Sato T
Third Department of Internal Medicine, Faculty of Medicine, University of Kumamoto, Japan.
Jpn Heart J. 1988 May;29(3):389-99. doi: 10.1536/ihj.29.389.
The case of a 69 year old man with a right adrenal pheochromocytoma who manifested cyclic fluctuations of blood pressure with a cycle length of 9 to 13 min is reported. We collected and reviewed 14 similar cases previously reported in the literature. In these cases, right adrenal pheochromocytoma was most common, while 1 case involved the left adrenal and 2 cases were of extra-adrenal origin. The incidence in males was twice that in females and the median age was 45.3 years. Although a good correlation between the blood pressure and plasma norepinephrine concentrations was observed in our patient, the exact mechanism for the cyclic fluctuations of blood pressure is not known. In our patient, both YM-09538 and bunazosin were effective in controlling severe hypertension preoperatively. YM-09538 induced significant increases in urinary norepinephrine concentrations (1327 +/- 238 micrograms/day), while bunazosin induced a significant decrement in urinary norepinephrine concentrations (475 +/- 188 micrograms/day) compared with pretreatment levels (900 +/- 42 micrograms/day) (p less than 0.01). These observations indicated that bunazosin as a postsynaptic alpha-adrenergic receptor blocker interfered with release of norepinephrine from the tumor and thus might be beneficial in the management of elevated blood pressure in patients with pheochromocytoma.
报告了一例69岁男性右肾上腺嗜铬细胞瘤患者，其血压呈周期性波动，周期长度为9至13分钟。我们收集并回顾了文献中先前报道的14例类似病例。在这些病例中，右肾上腺嗜铬细胞瘤最为常见，1例累及左肾上腺，2例为肾上腺外起源。男性发病率是女性的两倍，中位年龄为45.3岁。虽然在我们的患者中观察到血压与血浆去甲肾上腺素浓度之间有良好的相关性，但血压周期性波动的确切机制尚不清楚。在我们的患者中，YM-09538和布那唑嗪在术前控制严重高血压方面均有效。与治疗前水平（900±42微克/天）相比，YM-09538使尿去甲肾上腺素浓度显著升高（1327±238微克/天），而布那唑嗪使尿去甲肾上腺素浓度显著降低（475±188微克/天）（p<0.01）。这些观察结果表明，布那唑嗪作为一种突触后α-肾上腺素能受体阻滞剂，可干扰肿瘤去甲肾上腺素的释放，因此可能有助于治疗嗜铬细胞瘤患者的血压升高。
