Tcherdakoff P
Ann Med Interne (Paris). 1983;134(3):215-8.
The diagnostic problem of pheochromocytomas raises two questions: should all hypertensives be routinely investigated for this condition, and what is the best diagnostic method? As this is a rare condition, systematic screening gives a low return; considering the large number of hypertensive patients, it is also costly. On the other hand, as systematic autopsy studies have shown, the missed diagnosis can be serious (especially during pregnancy or surgery). Screening for this condition is proposed when the clinical features are suggestive, in pregnancy, when surgery is undertaken in a hypertensive patient and in all cases of method is still a matter of controversy: urinary hormonal levels (especially metanephrine levels) are supported by some workers, whilst serum catecholamine levels are supported by others. In any case, pharmacodynamic tests should only be used when these two methods are inconclusive. The long term prognosis of operated pheochromocytoma is less favourable then used to be thought: a certain number have persistent benign hypertension which may require treatment and which may become malignant at a later date. Adrenal medullary hyperplasia is a clinical entity which should be recognised.
是否应该对所有高血压患者进行这种疾病的常规检查，以及最佳诊断方法是什么？由于这是一种罕见疾病，系统筛查的回报较低；考虑到高血压患者数量众多，成本也很高。另一方面，正如系统尸检研究所示，漏诊可能很严重（尤其是在孕期或手术期间）。当临床特征提示该病时、孕期、高血压患者进行手术时以及所有儿童病例都建议进行筛查。诊断方法仍存在争议：一些研究人员支持检测尿激素水平（尤其是间甲肾上腺素水平），而另一些人则支持检测血清儿茶酚胺水平。无论如何，只有在这两种方法都无法得出结论时才应使用药效学试验。接受手术的嗜铬细胞瘤的长期预后比过去认为的要差：一定比例的患者会持续存在良性高血压，可能需要治疗，且后期可能会恶变。肾上腺髓质增生是一种应被认识的临床实体。
