Daskalov T R, Popnikolov S, Kusitasev G, Mantov S, Prodanov A
Vutr Boles. 1984;23(2):116-25.
The course of the disease of six cases with pheochromocytoma was analyzed in patients, aged from 19 to 65, with manifestations mainly of the cardiovascular system. The diagnosis was verified in five of them at necropsy and in one of them--intraoperatively. The arterial hypertension accompanied by distinct vegetative symptomatics were the basic clinical signs and in some of the cases--disturbances in the carbohydrate metabolism. In four patients the arterial hypertension was permanent, in two of them--with paroxysmal elevation opresf blood pressure. In the other two--with hypertonic crises on the background normal blood pressure. The duration of the hypertension--from a single hypertonic crisis during pheochromocytoma attack, had a lethal end, till the fifth year. In three of the patients rhythm disorders (supraventricular tachycardia or tachyarrhythmia) originated in a pheochromocytoma paroxysm and in three--acute left ventricular insufficiency (gallop rhythm, pulmonary edema). The clinical picture resembles heart defect, myocardial infarction with congestive cardiac insufficiency and rhythm disorders, renal insufficiency with symptomatic arterial hypertension and decompensated hypertonic heart, epilepsy, coggagenosis . The authors admit that the development of acute left ventricular failure in hypertonic patients, that could hardly be explained only by the increase of the heart afterloading (in advanced age, not enlarged and no data about grve heart lesions) or the origination of severe rhythm disorders, not coped by the modern antirhythm agents, are signs, indicating, the existence of pheochromocytoma. The catecholamine affection of myocardium, that was found in three of the deceased patients, very likely, contributes to the origination of left ventricular failure.
对6例嗜铬细胞瘤患者的病程进行了分析,患者年龄在19至65岁之间,主要表现为心血管系统症状。其中5例在尸检时确诊,1例在术中确诊。伴有明显植物神经症状的动脉高血压是基本临床体征,部分病例还伴有碳水化合物代谢紊乱。4例患者的动脉高血压为持续性,其中2例伴有血压阵发性升高。另外2例在血压正常的基础上出现高血压危象。高血压的持续时间从嗜铬细胞瘤发作时的单次高血压危象(最终致死)到5年不等。3例患者在嗜铬细胞瘤发作时出现心律失常(室上性心动过速或快速心律失常),3例出现急性左心室功能不全(奔马律、肺水肿)。临床表现类似于心脏缺陷、伴有充血性心力衰竭和心律失常的心肌梗死、伴有症状性动脉高血压和失代偿性高血压性心脏病的肾功能不全、癫痫、胶原病。作者承认,高血压患者出现急性左心室衰竭,很难仅用心脏后负荷增加(年龄较大,心脏未增大且无严重心脏病变数据)或出现严重心律失常(现代抗心律失常药物无法控制)来解释,这些迹象表明存在嗜铬细胞瘤。在3例死亡患者中发现的儿茶酚胺对心肌的影响很可能是导致左心室衰竭的原因。