Department of General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
Department of General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India.
BMJ Case Rep. 2021 Jun 24;14(6):e239991. doi: 10.1136/bcr-2020-239991.
A 60-year-old man presented with headache, giddiness, abdominal pain and palpitation. When evaluated outside for the same, the patient was diagnosed to have hypertension and started on antihypertensives for which he did not respond. ECG was suggestive of non-ST elevation myocardial infarction. The patient was subjected to a coronary angiogram, which was normal. Patient had multiple episodes of fluctuating blood pressures. CT of the abdomen showed a 7.1×5.6×8.2 cm mass in the left adrenal gland suggestive of a pheochromocytoma. Serum, urine metanephrines and normetanephrines were elevated. After discussing with the multidisciplinary team, the patient was stabilised with alpha blockers and taken up for laparoscopic left adrenalectomy. Histopathology was reported as pheochromocytoma with a Pheochromocytoma Adrenal Scaled Score of 10/20 suggestive of malignancy. This is one such case of a malignant pheochromocytoma, which was managed successfully despite the perplexities faced in stabilising the crisis followed by laparoscopic resection in a moribund patient.
一位 60 岁男性因头痛、头晕、腹痛和心悸就诊。在外地就诊时，患者被诊断为高血压，并开始服用降压药，但未得到缓解。心电图提示非 ST 段抬高型心肌梗死。对患者进行了冠状动脉造影检查，结果正常。患者多次出现血压波动。腹部 CT 显示左肾上腺有一个 7.1×5.6×8.2cm 的肿块，提示嗜铬细胞瘤。血清、尿液间甲肾上腺素和去甲肾上腺素升高。与多学科团队讨论后，患者先用α受体阻滞剂稳定病情，随后进行腹腔镜左肾上腺切除术。组织病理学报告为嗜铬细胞瘤，嗜铬细胞瘤肾上腺评分（Pheochromocytoma Adrenal Scaled Score）为 10/20，提示恶性。这是一例恶性嗜铬细胞瘤病例，尽管在稳定危象和濒死患者的腹腔镜切除方面遇到了困难，但仍成功得到了治疗。
