Spitzer D, Bongartz D, Ittel T H, Sieberth H G
Medizinische Klinik II, Universitätsklinikum der RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
Eur J Med Res. 1998 Dec 16;3(12):549-53.
A 46-year old female nursing sister was admitted to three different hospitals because of blood pressure crises of 300/150 mmHg which occurred up to six times a day. The rises in blood pressure were accompanied by headache, tachycardia and outbreaks of sweating. Raised catecholamine concentrations were repeatedly measured in the 24-hour urine and in the blood. The diagnosis of pheochromocytoma could therefore be regarded as confirmed. The investigations to establish the localization (including MIBG scintigrams carried out several times) showed negative results. Octreotide scintigraphy finally revealed a raised concentration of nuclides in the right adrenals. Selective venous blood samples showed markedly raised concentrations of adrenaline and noradrenaline in all regions investigated. After removing the right adrenal, which was of normal histological appearance, there was an improvement for six months. Afterwards, up to six blood pressure crises per day were observed once more. Fresh determination of catecholamines at various levels demonstrated the highest concentrations in the left iliac vein. It was then shown that the patient injected catecholamines intravaginally even during the angiographic investigation. A search of the patient s room revealed several ampoules containing noradrenaline and adrenaline as well as syringes and needles. - This case shows that in clinical pictures with typical clinical symptoms and negative results of repeated investigations a factitious disorder must be considered in terms of differential diagnosis especially when female patients with medical knowledge who have ready access to drugs are involved with a history comprising several stays in hospital which have not produced any clarification of their condition.
一名46岁的女性护士因每天出现多达6次的300/150 mmHg血压危机而被送往三家不同的医院。血压升高伴有头痛、心动过速和出汗发作。24小时尿液和血液中多次检测到儿茶酚胺浓度升高。因此，嗜铬细胞瘤的诊断可被视为得到证实。确定肿瘤位置的检查（包括多次进行的间碘苄胍闪烁扫描）结果均为阴性。奥曲肽闪烁扫描最终显示右肾上腺核素浓度升高。选择性静脉血样显示，在所有检测区域，肾上腺素和去甲肾上腺素的浓度均显著升高。切除组织学外观正常的右肾上腺后，病情有六个月的改善。之后，再次观察到每天出现多达6次的血压危机。对不同水平的儿茶酚胺进行重新检测发现，左髂静脉中的浓度最高。随后发现，即使在血管造影检查期间，该患者仍通过阴道内注射儿茶酚胺。搜查患者病房时发现了几个装有去甲肾上腺素和肾上腺素的安瓿以及注射器和针头。——该病例表明，对于具有典型临床症状且多次检查结果为阴性的临床情况，在鉴别诊断时必须考虑人为障碍，尤其是当涉及有医学知识且能轻易获取药物的女性患者，且其病史包括多次住院但病情仍未明确时。
