Jorge A A, Lucon A M, Bloise W, Mendonça B B
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1997 Jan-Feb;52(1):28-31.
Pheochromocytoma is a rare neoplasm, found in 0.1% of all hypertensive patients. Extraadrenal pheochromocytomas occur in 18% of all cases and 1% accurate in the bladder. In this study, we report a case of a vesical pheochromocytoma in a 40-year-old male patient with typical clinical symptoms for 6 years. He related episodes of severe headaches and palpitation with increase of the blood pressure after micturition, which decreased within a few seconds and fatigue afterwards. The patient was evaluated through urinary catecholamine (NE: 263 ug/24 h; E: 14 ug/ 24 h; Dopa: 303 ug/24 h; normal range respectively < 80; < 20 and < 400) and plasma catecholamine level determinations before and after micturition (NE: 1.660-->34.790 pg/ml; E: 55-->231 pg/ml-normal range respectively < 268 and < 75). Magnetic resonance imaging, sonography and 131Iodine-methiliodobenzylguanidine scintigraphy were performed for diagnostic localization. In this case plasma catecholamine level determinations before and after voiding were important to confirm the diagnosis. All imaging techniques were able to disclose the tumor. Typical symptoms, diagnoses and therapy for vesical pheochromocytoma are described and compared to the reports found in the literature.
嗜铬细胞瘤是一种罕见肿瘤，在所有高血压患者中占0.1%。肾上腺外嗜铬细胞瘤在所有病例中占18%，膀胱嗜铬细胞瘤占1%。在本研究中，我们报告了一例40岁男性膀胱嗜铬细胞瘤患者，其有6年典型临床症状。他诉说排尿后出现严重头痛和心悸，血压升高，数秒内血压下降，随后感到疲劳。通过测定排尿前后尿儿茶酚胺（去甲肾上腺素：263μg/24小时；肾上腺素：14μg/24小时；多巴：303μg/24小时；正常范围分别为<80、<20和<400）和血浆儿茶酚胺水平对患者进行评估（去甲肾上腺素：1.660-->34.790pg/ml；肾上腺素：55-->231pg/ml，正常范围分别为<268和<75）。进行了磁共振成像、超声检查和131碘-间碘苄胍闪烁扫描以进行诊断定位。在该病例中，排尿前后血浆儿茶酚胺水平测定对确诊很重要。所有成像技术均能发现肿瘤。描述了膀胱嗜铬细胞瘤的典型症状、诊断和治疗，并与文献报道进行了比较。
