Ferguson K L
Department of Surgery, University of Michigan Medical Center, Ann Arbor.
Am J Emerg Med. 1994 Mar;12(2):190-2. doi: 10.1016/0735-6757(94)90245-3.
The dramatic presentation of pheochromocytoma in crisis is uncommon and is classically associated with a state of hemodynamic and sympathetic hyperactivity. The case of a 35-year-old man with an occult pheochromocytoma presenting with hypotension and cardiogenic shock shortly after beginning imipramine therapy is presented. Retrospectively, there was a history of emergency department, inpatient, and outpatient evaluation of symptoms likely to be related to an occult pheochromocytoma. He presented with hypotension refractory to fluids and inotropes and in severe respiratory distress. The early differential diagnosis was extensive including acute myocardial infarction, pneumonia with sepsis, and toxic ingestion. Shortly after admission the patient's occult pheochromocytoma was discovered and subsequently specific therapy was initiated. The patient's symptoms resolved after surgical resection of the tumor, and he was ultimately discharged without signs of congestive heart failure. The clinical pathophysiology of cardiomyopathy secondary to pheochromocytoma, and possible mechanisms of pharmacological interactions with tricyclic antidepressants are discussed.
嗜铬细胞瘤危象的戏剧性表现并不常见，经典地与血流动力学和交感神经过度活跃状态相关。本文介绍了一名35岁男性患者的病例，该患者隐匿性嗜铬细胞瘤在开始丙咪嗪治疗后不久出现低血压和心源性休克。回顾性分析发现，患者有急诊科、住院部和门诊对可能与隐匿性嗜铬细胞瘤相关症状的评估病史。他表现为对液体和血管活性药物难治的低血压，并伴有严重的呼吸窘迫。早期鉴别诊断范围广泛，包括急性心肌梗死、肺炎伴脓毒症和药物中毒。入院后不久发现了患者隐匿性嗜铬细胞瘤，随后开始了特异性治疗。手术切除肿瘤后患者症状缓解，最终出院时无充血性心力衰竭迹象。本文还讨论了嗜铬细胞瘤继发心肌病的临床病理生理学，以及与三环类抗抑郁药发生药物相互作用的可能机制。
