Lucon A M, Pereira M A, Mendonça B B, Halpern A, Wajchenbeg B L, Arap S
Departamento of Cirurgia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
J Urol. 1997 Apr;157(4):1208-12. doi: 10.1016/s0022-5347(01)64925-5.
We studied the clinical picture, sensitivity of the biochemical tests and imaging studies, pathological findings, surgical results and followup of patients with pheochromocytoma.
The records of 50 patients with pheochromocytoma were identified. Hyperadrenergic symptoms and signs; urinary dopamine, epinephrine, norepinephrine and vanillylmandelic acid levels; serum dopamine, epinephrine and norepinephrine levels; ultrasonography; computerized tomography; magnetic resonance imaging and 131iodine-metaiodobenzylguanidine images were analyzed. The size, weight and malignancy of the tumors, as well as the operative mortality, survival rate and clinical condition of the patients were also studied.
The hyperadrenergic syndrome alone was found in 90% of the patients, Cushing's syndrome alone in 2%, both syndromes in 4%, a palpable abdominal tumor only in 2% and incidental tumors in 2%. The sensitivities of the urinary evaluation in the diagnosis were metanephrines 97%, vanillylmandelic acid 90%, epinephrine 64%, norepinephrine 93% and dopamine 66%. For serum assessment the sensitivities were epinephrine 67%, norepinephrine 93% and dopamine 63%. The sensitivities of the localization examinations were 89, 94, 100 and 88% for ultrasonography, computerized tomography, magnetic resonance imaging and 131I-metaiodobenzylquanidine, respectively. There was only 1 operative death. Of the patients with benign tumors 88% were cured and 12% remained hypertensive with no clinical or biochemical evidence of a hyperadrenergic profile. Of the 8 patients with malignant pheochromocytoma 1 was lost to followup and 3 died of widespread disease (1 without surgery and at 2, 24 and 78 months postoperatively). Of the 4 living patients 3 had no evidence of disease and 1 was well, although with pulmonary metastases.
我们研究了嗜铬细胞瘤患者的临床表现、生化检查及影像学检查的敏感性、病理结果、手术结果及随访情况。
确定了50例嗜铬细胞瘤患者的记录。分析了高肾上腺素能症状和体征；尿多巴胺、肾上腺素、去甲肾上腺素和香草扁桃酸水平；血清多巴胺、肾上腺素和去甲肾上腺素水平；超声检查；计算机断层扫描；磁共振成像和131碘-间碘苄胍图像。还研究了肿瘤的大小、重量和恶性程度，以及患者的手术死亡率、生存率和临床状况。
仅高肾上腺素能综合征见于90%的患者，仅库欣综合征见于2%的患者，两种综合征均见于4%的患者，仅可触及腹部肿瘤见于2%的患者，偶然发现的肿瘤见于2%的患者。诊断中尿评估的敏感性分别为：甲氧基肾上腺素97%、香草扁桃酸90%、肾上腺素64%、去甲肾上腺素93%和多巴胺66%。血清评估的敏感性分别为：肾上腺素67%、去甲肾上腺素93%和多巴胺63%。定位检查的敏感性分别为：超声检查89%、计算机断层扫描94%、磁共振成像100%和131I-间碘苄胍88%。仅1例手术死亡。良性肿瘤患者中88%治愈，12%仍有高血压，无高肾上腺素能状态的临床或生化证据。8例恶性嗜铬细胞瘤患者中，1例失访，3例死于广泛转移（1例未手术，术后2、24和78个月各1例）。4例存活患者中，3例无疾病证据，1例情况良好，尽管有肺转移。
