Hermel Melody, Jones Daniel, Olson Cheryl, Sherman Mark, Srivastava Ajay
Cardiology, Scripps Health, San Diego, CA, USA.
Pulmonology/Critical Care, Scripps Health, San Diego, CA, USA.
Rare Tumors. 2021 Apr 9;13:20363613211007792. doi: 10.1177/20363613211007792. eCollection 2021.
A case of pheochromocytoma producing vasoactive intestinal peptide (VIP) and left ventricular thrombus in the absence of cardiomyopathy or wall motion abnormalities on echocardiogram is presented along with a review of the relevant literature. A 30-year-old female of Afghani descent with past medical history of panic attacks presented with fever, cough, sore throat, vomiting, and was found to have an 11 cm adrenal mass consistent with primary adrenocortical adenoma versus carcinoma. Her tumor elicited catechols and vasoactive intestinal peptide. Her hospitalization was complicated by left ventricular thrombosis leading to an embolic injury to her right kidney, respiratory failure, need for transient dialysis and urinary tract infections. She developed a profuse secretory diarrhea and decision was made to treat with empiric octreotide infusion and imodium with improvement in symptoms. She underwent coil and particle embolization followed by resection. Followup PET gallium scan showed no evidence of residual disease or metastasis. VIP producing pheochromocytoma associated with intracardiac thrombosis is rare. Outcomes depend on prompt diagnosis of the pheochromocytoma and multidisciplinary approach to management.
本文报告了一例分泌血管活性肠肽（VIP）的嗜铬细胞瘤病例，该病例在超声心动图检查中未发现心肌病或室壁运动异常，但出现了左心室血栓形成，并对相关文献进行了综述。一名30岁的阿富汗裔女性，既往有惊恐发作病史，因发热、咳嗽、咽痛、呕吐就诊，检查发现一个11厘米的肾上腺肿块，考虑为原发性肾上腺皮质腺瘤或癌。她的肿瘤分泌儿茶酚胺和血管活性肠肽。她的住院治疗因左心室血栓形成而复杂化，导致右肾栓塞性损伤、呼吸衰竭、需要进行短期透析和尿路感染。她出现了大量分泌性腹泻，决定给予经验性奥曲肽输注和易蒙停治疗，症状有所改善。她接受了弹簧圈和颗粒栓塞治疗，随后进行了手术切除。随访的PET镓扫描显示没有残留疾病或转移的证据。分泌VIP的嗜铬细胞瘤合并心内血栓形成很罕见。预后取决于嗜铬细胞瘤的及时诊断和多学科管理方法。
