Miyajima A, Nakashima J, Baba S, Tachibana M, Nakamura K, Murai M
Department of Urology, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
J Urol. 1997 May;157(5):1566-8.
We reviewed 17 resected pheochromocytomas comprising 7 from symptomatic patients, and 10 unsuspected and incidentally discovered tumors. We compared various parameters concerning these 2 groups and investigated the features of the incidentally discovered pheochromocytoma.
Patient gender and age, clinical symptoms and signs, tumor localization, detection methods, findings on imaging studies, urinary catecholamine concentrations, results of metoclopramide stimulation tests, treatments at operation and tumor size were evaluated. Furthermore, we compared the clinically diverse aspects arising between the symptomatic and incidentally discovered pheochromocytomas.
The 24-hour urinary noradrenaline and vanillylmandelic acid levels in the incidental cases tended to be lower than those in the symptomatic cases, while 24-hour urinary dopamine was significantly less (468 +/- 221 compared to 1,558 +/- 899 microg./day, respectively). Typical symptoms of pheochromocytoma were noted in 6 patients (60%) in the incidental tumor group. The incidental cases had a markedly high false-negative rate (71%) as noted by the metoclopramide stimulation test, although the symptomatic cases had a 100% positive rate. On the other hand, the average diameter of incidental tumors was significantly larger than that of the symptomatic lesions (55.5 +/- 19.1 versus 35.9 +/- 12.1 mm., respectively).
Clinical signs and findings in patients with incidental tumors were weaker than those with symptomatic disease although most incidental tumors functioned. Lower urinary catecholamine values in the incidental tumors were consistent with these results. However, the surgical risk for incidental tumors was the same as that for symptomatic lesions. Therefore, patients with incidentally discovered pheochromocytomas scheduled to undergo surgery should be treated accordingly.
我们回顾了17例切除的嗜铬细胞瘤，其中7例来自有症状的患者，10例为意外发现且偶然检出的肿瘤。我们比较了这两组的各种参数，并研究了偶然发现的嗜铬细胞瘤的特征。
评估患者的性别和年龄、临床症状和体征、肿瘤定位、检测方法、影像学检查结果、尿儿茶酚胺浓度、甲氧氯普胺刺激试验结果、手术治疗情况和肿瘤大小。此外，我们比较了有症状和偶然发现的嗜铬细胞瘤之间出现的临床不同方面。
偶然发现病例的24小时尿去甲肾上腺素和香草扁桃酸水平往往低于有症状病例，而24小时尿多巴胺水平明显较低（分别为468±221与1558±899微克/天）。偶然肿瘤组中有6例患者（60%）出现嗜铬细胞瘤的典型症状。甲氧氯普胺刺激试验显示，偶然发现病例的假阴性率明显较高（71%），而有症状病例的阳性率为100%。另一方面，偶然发现肿瘤的平均直径明显大于有症状病变的平均直径（分别为55.5±19.1与35.9±12.1毫米）。
偶然发现肿瘤患者的临床体征和表现比有症状疾病患者的要轻，尽管大多数偶然发现的肿瘤有功能。偶然发现肿瘤中较低的尿儿茶酚胺值与这些结果一致。然而，偶然发现肿瘤的手术风险与有症状病变的相同。因此，计划接受手术的偶然发现嗜铬细胞瘤患者应相应地进行治疗。
