Jung Sodam, Kang In Sook
Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Clin Hypertens. 2022 Feb 1;28(1):4. doi: 10.1186/s40885-021-00189-9.
The signs and symptoms of pheochromocytoma can imitate those of many other diseases, which may result in confusion. Therefore, diagnosing and treating secondary hypertension due to pheochromocytoma in deteriorating patients becomes challenging.
A 63-year-old female patient presented to the emergency room with severe and progressive nausea. The initial diagnosis was an acute myocardial infarction based on ST-segment depression on electrocardiogram and elevated cardiac markers. Elective coronary angiography revealed nonobstructive coronary arteries. However, she suffered from a complicated clinical course for several weeks during her life-or-death crisis. She was subsequently diagnosed with a cerebral hemorrhage and a pheochromocytoma. It is unclear whether her initial presentation was due to the neurogenic stunned myocardium caused by a cerebral hemorrhage or type 2 myocardial infarction caused by a pheochromocytoma, or both. However, this case showed the significance of accurately diagnosing and treating underlying causes in patients presenting with myocardial infarction with nonobstructive coronary arteries. Early diagnosis and treatment of the pheochromocytoma may have prevented the complications experienced by the patient.
A catecholamine surge and blood pressure fluctuation caused severe complications. When a patient presents with an unusual clinical presentation, secondary hypertension due to pheochromocytoma should be suspected.
嗜铬细胞瘤的体征和症状可模仿许多其他疾病的表现，这可能导致诊断混淆。因此，在病情恶化的患者中诊断和治疗由嗜铬细胞瘤引起的继发性高血压具有挑战性。
一名63岁女性患者因严重且进行性恶心就诊于急诊室。根据心电图上的ST段压低和心脏标志物升高，初步诊断为急性心肌梗死。选择性冠状动脉造影显示冠状动脉无阻塞。然而，在生死危机期间，她经历了数周复杂的临床病程。随后她被诊断出患有脑出血和嗜铬细胞瘤。尚不清楚她最初的表现是由脑出血引起的神经源性心肌顿抑，还是由嗜铬细胞瘤引起的2型心肌梗死，或者两者皆有。然而，该病例显示了准确诊断和治疗无阻塞性冠状动脉心肌梗死患者潜在病因的重要性。早期诊断和治疗嗜铬细胞瘤可能会预防患者出现的并发症。
儿茶酚胺激增和血压波动导致了严重并发症。当患者出现不寻常的临床表现时，应怀疑由嗜铬细胞瘤引起的继发性高血压。
