Reti Zsuzsanna, Szabo Laszlo, Neagoe Radu M, Kolcsar Melinda
Department of Endocrinology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, ROU.
2nd Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, ROU.
Cureus. 2024 Jun 11;16(6):e62123. doi: 10.7759/cureus.62123. eCollection 2024 Jun.
Pheochromocytoma rarely presents with unexplained hypokalaemia, although there are some case reports in the literature. The mechanism behind this could be the increased cellular potassium uptake promoted by beta-2-adrenoreceptor hyperactivation and insulin resistance. We present the case of a 68-year-old hypertensive female patient with a unilateral adrenal mass discovered on angio-CT and typical signs of adrenergic hyperstimulation (hypertensive crisis, headache, and sweating) associated with multiple arrhythmic episodes but with normal plasma and urinary catecholamine levels. During the work-up for hormonal hypersecretion and the cessation of anti-aldosterone medication, the patient presented resistant hypokalaemia. Due to uncorrectable hypokalaemia, we were unable to perform hormonal investigations for primary hyperaldosteronism and referred the patient for laparoscopic adrenalectomy. The histological diagnosis revealed left pheochromocytoma. Postoperatively, the patient experienced rebound hyperkalaemia. In a patient with a unilateral adrenal mass and hypokalaemia, besides primary hyperaldosteronism and adrenocorticotropic hormone-independent hypercortisolism, a possible pheochromocytoma should be ruled out as well by the clinician before surgery.
嗜铬细胞瘤很少表现为不明原因的低钾血症，尽管文献中有一些病例报告。其背后的机制可能是β-2肾上腺素能受体过度激活和胰岛素抵抗促进细胞对钾的摄取增加。我们报告一例68岁高血压女性患者，血管CT发现单侧肾上腺肿块，伴有肾上腺素能过度刺激的典型症状（高血压危象、头痛和出汗）以及多次心律失常发作，但血浆和尿儿茶酚胺水平正常。在对激素分泌过多进行检查以及停用抗醛固酮药物期间，患者出现顽固性低钾血症。由于低钾血症无法纠正，我们无法对原发性醛固酮增多症进行激素检查，遂将患者转诊进行腹腔镜肾上腺切除术。组织学诊断为左侧嗜铬细胞瘤。术后，患者出现反弹性高钾血症。对于单侧肾上腺肿块和低钾血症患者，除原发性醛固酮增多症和促肾上腺皮质激素非依赖性皮质醇增多症外，临床医生在手术前也应排除嗜铬细胞瘤的可能。
