Rampuria Archana, Mathew Thomas, Honnali Ravindranath Aditya
Dept of Medicine, St John's National Academy of Health Sciences, Bangalore, Karnataka, India.
Dept of Neurology, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
BMJ Case Rep. 2024 Feb 6;17(2):e257899. doi: 10.1136/bcr-2023-257899.
We report the case of a middle-aged hypertensive woman presenting to the neurology department with short-lasting episodic headaches for 4 years. She was initially diagnosed and treated with cluster headaches for one year. Following this, she presented with right lower limb arterial claudication. Arterial Doppler of lower limbs showed thrombosis of the bilateral common femoral arteries. Further computed tomography (CT) angiogram of the lower limbs confirmed extensive arterial thrombosis in bilateral lower limbs. The CT angiogram incidentally detected a left adrenal lesion. She had elevated urinary vanillylmandelic Acid and 24-hour metanephrines suggesting the presence of a pheochromocytoma. She was initially medically managed and later underwent left open adrenalectomy. Histopathology examination of the sections proved pheochromocytoma. Postsurgery, the patient's symptoms improved remarkably. This case highlights the importance of diagnosing pheochromocytoma when you encounter a patient with refractory short-lasting headaches, hypertension and hypercoagulability.
我们报告了一例中年高血压女性病例,该患者因持续4年的短暂发作性头痛就诊于神经科。她最初被诊断为丛集性头痛并接受了一年的治疗。此后,她出现了右下肢动脉间歇性跛行。下肢动脉多普勒检查显示双侧股总动脉血栓形成。进一步的下肢计算机断层扫描(CT)血管造影证实双侧下肢存在广泛的动脉血栓形成。CT血管造影偶然发现左侧肾上腺病变。她的尿香草扁桃酸和24小时间甲肾上腺素升高,提示存在嗜铬细胞瘤。她最初接受药物治疗,后来接受了左侧开放性肾上腺切除术。切片的组织病理学检查证实为嗜铬细胞瘤。术后,患者的症状明显改善。该病例强调了在遇到难治性短暂性头痛、高血压和高凝状态患者时诊断嗜铬细胞瘤的重要性。