Ram C V, Engelman K
Curr Probl Cardiol. 1979 Apr;4(1):1-37. doi: 10.1016/s0146-2806(79)80003-1.
Pheochromocytoma is an infrequent cause of hypertension. In spite of its rarity, pheochromocytoma has assumed notorious importance because or a wide variety of clinical features associated with this syndrome. Hypertension remains the most important clinical lead. The presence of other features, such as severe headache, perspiration, palpitations or orthostatic hypotension, makes the diagnosis of pheochromocytoma likely. The diagnosis of this condition can be made with greater certainty than that of any other form of secondary hypertension. Pharmacologic tests are no longer used for evaluation purposes. Biochemical tests are the most important aids to diagnosis, provided highly specific methods are used to determine the levels of urinary catecholamines or their metabolites. Interference by various drugs should be avoided. Most of the pheochromocytomas are found in the abdomen, predominantly in the adrenals. Successful outcome of surgery depends critically on adequate preoperative preparation of the patient with adrenergic blocking drugs and proper intraoperative care. Surgery should only be performed in an institution with experience in treating these tumors. Invasive localizing procedures could be dangerous in patients with pheochromocytoma and are best avoided. Medical therapy proves to be quite successful for those patients who are unable or unwilling to undergo surgery and for those with demonstrated malignant tumor. The postoperative course in most instances is uneventful. The physician should be aware of familial forms of pheochromocytomas and screen all the hypertensive members of the patient's family for the presence of this condition. Pheochromocytoma, with its multiple facets, presents a challenge to the clinician; however, with prompt diagnosis and proper treatment, pheochromocytoma can often be cured. The improved management of patients with this potentially lethal condition is the result of better knowledge of biochemical pharmacology, improved preoperative, surgical and postoperative care.
嗜铬细胞瘤是高血压的罕见病因。尽管其罕见，但嗜铬细胞瘤因其与该综合征相关的多种临床特征而具有显著的重要性。高血压仍然是最重要的临床线索。其他特征的存在，如严重头痛、出汗、心悸或体位性低血压，使嗜铬细胞瘤的诊断成为可能。与其他任何形式的继发性高血压相比，这种疾病的诊断可以更确定地做出。药理试验不再用于评估目的。生化试验是诊断的最重要辅助手段，前提是使用高度特异性的方法来测定尿儿茶酚胺或其代谢产物的水平。应避免各种药物的干扰。大多数嗜铬细胞瘤位于腹部，主要在肾上腺。手术的成功结果关键取决于用肾上腺素能阻断药物对患者进行充分的术前准备以及适当的术中护理。手术应仅在有治疗这些肿瘤经验的机构进行。侵入性定位程序对嗜铬细胞瘤患者可能有危险，最好避免。对于那些无法或不愿意接受手术的患者以及那些已证实患有恶性肿瘤的患者，药物治疗证明相当成功。在大多数情况下，术后过程平稳。医生应了解嗜铬细胞瘤的家族形式，并对患者家族中所有高血压成员进行该疾病的筛查。嗜铬细胞瘤具有多方面特点，给临床医生带来了挑战；然而，通过及时诊断和适当治疗，嗜铬细胞瘤通常可以治愈。对这种潜在致命疾病患者管理的改善是对生化药理学有更好了解、术前、手术和术后护理得到改善的结果。
