Melson Eka, Amir Sidra, Shepherd Lisa, Kauser Samina, Freestone Bethan, Kempegowda Punith
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Endocrinol Diabetes Metab Case Rep. 2019 Oct 19;2019. doi: 10.1530/EDM-19-0089.
Although pheochromocytoma classically presents with headaches, palpitations and paroxysmal hypertension, atypical presentations such as cardiomyopathy, stroke and subarachnoid haemorrhage have been infrequently documented. We present in this case report, an uncommon presentation of pheochromocytoma with myocardial infarction with normal coronary arteries (MINOCA). A 79-year-old woman presented with central crushing chest pain radiating to left arm associated with headache, palpitations, sweating and difficulty in breathing. For 2 years, she experienced brief episodes of headache, tinnitus, dizziness, palpitations, and sweating that spontaneously resolved. Clinical examination was unremarkable except for high blood pressure (210/105 mmHg). Her electrocardiogram showed T wave inversions from V1 to V6 and elevated troponins (774 ng/L at baseline and 932 ng/L 3 h from baseline (normal <16 ng/L) in keeping with a diagnosis of non-ST elevated myocardial infarction. Coronary angiography showed normal coronary arteries. Patient was hence treated as myocardial infarction with normal coronaries (MINOCA). Despite appropriate treatment for MINOCA, she continued to experience episodic headaches, palpitations, dizziness and erratic blood pressures (particularly severe hypertension shortly after beta-blocker administration). Further investigations revealed raised urine noradrenaline of 4724 nmol/24 h (<554 nmol/24 h) and urine adrenaline of 92863 nmol/24 h (<77 nmol/24 h). Computerised tomography demonstrated a well-defined rounded mass in right adrenal gland morphological of pheochromocytoma. She underwent laparoscopic right adrenalectomy with histology confirming pheochromocytoma. This case highlights the importance of thorough investigation for the underlying cause for MINOCA. In patients with unexplained erratic blood pressure control, pheochromocytoma should be considered as a differential diagnosis.
Pheochromocytoma is rare tumour that often presents with non-specific symptoms. It is important to investigate underlying cause of MINOCA. Thorough history is the key to diagnosis.
虽然嗜铬细胞瘤典型表现为头痛、心悸和阵发性高血压，但诸如心肌病、中风和蛛网膜下腔出血等非典型表现鲜有记录。在本病例报告中，我们呈现了一例伴有正常冠状动脉心肌梗死（MINOCA）的嗜铬细胞瘤罕见表现。一名79岁女性因中央压榨性胸痛放射至左臂就诊，伴有头痛、心悸、出汗和呼吸困难。两年来，她经历过短暂的头痛、耳鸣、头晕、心悸和出汗发作，这些症状可自行缓解。除高血压（210/105 mmHg）外，临床检查无异常。她的心电图显示V1至V6导联T波倒置，肌钙蛋白升高（基线时为774 ng/L，基线后3小时为932 ng/L，正常<16 ng/L），符合非ST段抬高型心肌梗死的诊断。冠状动脉造影显示冠状动脉正常。因此，该患者被诊断为正常冠状动脉心肌梗死（MINOCA）并接受治疗。尽管对MINOCA进行了适当治疗，但她仍持续出现发作性头痛、心悸、头晕和血压波动（特别是在使用β受体阻滞剂后不久出现严重高血压）。进一步检查发现尿去甲肾上腺素升高至4724 nmol/24 h（<554 nmol/24 h），尿肾上腺素升高至92863 nmol/24 h（<77 nmol/24 h）。计算机断层扫描显示右肾上腺有一个边界清晰的圆形肿块，形态符合嗜铬细胞瘤。她接受了腹腔镜右肾上腺切除术，组织学检查证实为嗜铬细胞瘤。本病例强调了对MINOCA潜在病因进行全面调查的重要性。在血压控制不明原因波动的患者中，应考虑嗜铬细胞瘤作为鉴别诊断。
嗜铬细胞瘤是一种罕见肿瘤，常表现为非特异性症状。调查MINOCA的潜在病因很重要。详尽的病史是诊断的关键。
