Fajardo Roosevelt, García Nicole, Díaz Francisco
Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia.
Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia.
Int J Surg Case Rep. 2020;71:353-359. doi: 10.1016/j.ijscr.2020.05.027. Epub 2020 May 23.
Pheochromocytomas are rare neuroendocrine tumors that form in chromaffin cells of the neural crest during the embryological period. In the overall population, incidence rate is 0.1%; lack of early diagnosis or adequate treatment can lead to life-threatening complications. The secretion of catecholamines, such as adrenaline or norepinephrine, produces paroxysmal headache, palpitations and arterial hypertension. Secondary, hyperglycemic crises may also appear, thus contributing to misdiagnosis of diabetes mellitus or diabetic ketoacidosis. Surgery prevails as primary treatment; despite its subsequent high mortality rate of up to 50% during the intra and postoperative periods.
We describe the case of a 55-year-old man, diagnosed in 2012 with arterial hypertension and almost uncontrollable labile arterial hypertension, who had been medicated with second and third-line antihypertensive drugs, but, who, nonetheless showed no clinical improvement. Biochemical profile studies showed elevated normetanephrine and metanephrine levels; and an abdominal MRI, a markedly vascularized, 72 × 62 mm diameter solid mass in the right adrenal fossa; thereby leading to its classification as a large, noradrenergic phenotype pheochromocytoma.
In 2018, at the Fundación de Santa Fe de Bogotá Hospital, patient underwent Transperitoneal Laparoscopic Adrenalectomy, which proceeded without complications. In the 6-month postoperative follow-up, patient remained asymptomatic for cardiovascular risk and maintained stable blood pressure within goals; consequently, antihypertensive therapy was suspended.
Despite advances in surgical technique and perioperative management, minimally invasive surgery for resection of large pheochromocytoma is a challenging procedure, due to risk of intraoperative hemodynamic instability.
嗜铬细胞瘤是一种罕见的神经内分泌肿瘤，在胚胎期由神经嵴的嗜铬细胞形成。在总体人群中，发病率为0.1%；缺乏早期诊断或充分治疗可导致危及生命的并发症。儿茶酚胺（如肾上腺素或去甲肾上腺素）的分泌会引起阵发性头痛、心悸和动脉高血压。其次，还可能出现高血糖危象，从而导致糖尿病或糖尿病酮症酸中毒的误诊。手术是主要的治疗方法；尽管在术中及术后其随后的死亡率高达50%。
我们描述了一名55岁男性的病例，该患者于2012年被诊断为动脉高血压，且患有几乎无法控制的不稳定动脉高血压，曾使用二线和三线抗高血压药物治疗，但仍未显示出临床改善。生化指标研究显示去甲变肾上腺素和变肾上腺素水平升高；腹部MRI显示右肾上腺窝有一个直径72×62mm、明显血管化的实性肿块；因此将其分类为大的、去甲肾上腺素能表型嗜铬细胞瘤。
2018年，该患者在波哥大圣菲基金会医院接受了经腹腹腔镜肾上腺切除术，手术过程无并发症。术后6个月的随访中，患者无心血管风险症状，血压维持在目标范围内稳定；因此停用了抗高血压治疗。
尽管手术技术和围手术期管理取得了进展，但由于术中血流动力学不稳定的风险，切除大型嗜铬细胞瘤的微创手术仍是一项具有挑战性的手术。
