接受产生白细胞介素-6的嗜铬细胞瘤切除术患者的围手术期管理

Perioperative management of a patient undergoing resection of interleukin-6 producing pheochromocytoma.

作者信息

Kuroki Masahiro, Suzuki Hiroto, Kurota Misato, Nakane Masaki, Kawamae Kaneyuki

机构信息

Department of Anesthesiology, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata City, Yamagata, 990-9585, Japan.

Critical Care Center, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata City, Yamagata, 990-9585, Japan.

出版信息

JA Clin Rep. 2021 Jun 11;7(1):49. doi: 10.1186/s40981-021-00449-5.

DOI:10.1186/s40981-021-00449-5

PMID:34117557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8196126/

Abstract

BACKGROUND

Pheochromocytomas produce hormones, cytokines, and catecholamines. We report perioperative anesthetic management of a rare interleukin-6 (IL-6)-producing pheochromocytoma.

CASE PRESENTATION

A 32-year-old female was scheduled for laparoscopic adrenalectomy for pheochromocytoma. She had a sustained high fever with elevated serum noradrenaline and IL-6 levels. The persistent high inflammatory state, followed by anemia, malnutrition, and coagulopathy, led us to prepone her date of surgery. During general anesthesia, alpha-blockers allowed hemodynamic fluctuations to be controlled. During surgery, simultaneous increases in noradrenaline and IL-6 levels were observed, which rapidly declined after tumor removal. Her postoperative course was uneventful, without pulmonary edema caused by cytokine storms.

CONCLUSIONS

The conventional pheochromocytoma strategy allowed surgical removal of an IL-6-producing pheochromocytoma under general anesthesia. However, management of high inflammatory states that induce anemia and coagulopathy is necessary.

摘要

背景

嗜铬细胞瘤可产生激素、细胞因子和儿茶酚胺。我们报告了一例罕见的产生白细胞介素-6（IL-6）的嗜铬细胞瘤的围手术期麻醉管理。

病例介绍

一名32岁女性计划接受腹腔镜肾上腺切除术治疗嗜铬细胞瘤。她持续高热，血清去甲肾上腺素和IL-6水平升高。持续的高炎症状态，继而出现贫血、营养不良和凝血功能障碍，促使我们提前了她的手术日期。在全身麻醉期间，α受体阻滞剂可控制血流动力学波动。手术过程中，观察到去甲肾上腺素和IL-6水平同时升高，肿瘤切除后迅速下降。她的术后过程顺利，未发生细胞因子风暴引起的肺水肿。