Brandão A, Gomes A, Pereira M, Brandão I, Basto L, Delgado M, Gonçalves C, Lemos P, Falcão J, Rodrigues P
Serviço de Cardiologia, Hospital de S. Marcos de Braga.
Rev Port Cardiol. 1993 Jul-Aug;12(7-8):647-50, 601.
A case of a 43-year-old woman with severe sustained hypertension resistant to many antihypertensive drugs, frequent hypertensive crisis and symptoms suggestive of pheochromocytoma (symptomatic triad) is presented. Three of the four determinations of the urinary catecholamines metabolites have been normal as it was the only determination of plasmatic catecholamines. Abdominal sonography and CT scan detected a left adrenal mass, that have been histologically confirmed, after surgery, to be a pheochromocytoma. After adrenalectomy, the patient symptoms disappeared but she maintained mild hypertension easily controlled with drugs. The finding of normal plasmatic and urinary catecholamines values in a patient with sustained hypertension may suggest that we are handling with a case of essential hypertension and a superimposed pheochromocytoma with paroxysmal secretion. Some considerations are made essentially about specificity and sensitivity of diagnostic tests.
本文介绍了一例43岁女性患者，患有严重的持续性高血压，对多种降压药物耐药，频繁发生高血压危象，并伴有提示嗜铬细胞瘤的症状（症状三联征）。尿儿茶酚胺代谢产物的四次测定中有三次结果正常，血浆儿茶酚胺的测定结果也是如此。腹部超声和CT扫描发现左侧肾上腺有一个肿块，手术后经组织学证实为嗜铬细胞瘤。肾上腺切除术后，患者症状消失，但仍维持轻度高血压，药物治疗很容易控制。在持续性高血压患者中发现血浆和尿儿茶酚胺值正常，可能提示我们正在处理一例原发性高血压合并阵发性分泌的叠加嗜铬细胞瘤病例。本文主要对诊断试验的特异性和敏感性进行了一些思考。
