Pheochromocytoma complicated with severe ventricular tachycardia: report of one case.

Yu-Chih Huang, Chao-Hsiang Chang, Chung-Hsing Wang, Jeng-Sheng Chang
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Abstract

Pheochromocytoma in children shows much worse complications than that in the adult patients. An 11-year-old girl was transferred to our emergency room after suffering from headache, dizziness, cold sweating and palpitation for 3 days. Severe hypertension, remarkable blood pressure fluctuation between 260/160 and 65/50 mmHg, decrease of cardiac contractility, as well as abnormal electrocardiogram findings including ST-T segment elevation and QT interval prolongation were noted soon after admission. Later, a 4x4.5x2.5 cm tumor in the right adrenal gland area was found by computed axial tomogram study. Assessment of the urine catecholamine metabolites showed high levels of vanillylmandelic acid, normetanephrine and norepinephrine indicating an active adrenal pheochromocytoma produced mainly norepinephrine. Although several antihypertensive drugs were used, ventricular tachycardia and Torsade de pointe still occurred on her for 3 times, each was preceded by a period of blood pressure fluctuation and burst out concomitantly at the peak of a hypertension crisis. From this case, we found that when the specific alpha-blocker like phenoxybenzamine or phentolamine was not available to us, labetalol by continuous intravenous infusion was the only effective drug to protect the patient from attacks of hypertensive crisis and ventricular tachycardia. Her right adrenal gland was resected smoothly when BP was well under control. Histological examination showed the adrenal medulla was full of pheochromocytoma cells.

嗜铬细胞瘤合并严重室性心动过速1例报告。
儿童嗜铬细胞瘤的并发症比成人患者严重得多。一名11岁女童因头痛、头晕、冷汗、心悸3天入院。入院后不久即出现严重高血压,血压在260/160 ~ 65/50 mmHg之间波动明显,心脏收缩力下降,ST-T段抬高、QT间期延长等心电图异常。随后行计算机轴位断层扫描,发现右侧肾上腺区一4x4.5x2.5 cm肿瘤。尿液儿茶酚胺代谢物的评估显示高水平的香草扁桃酸,去甲肾上腺素和去甲肾上腺素表明一个活跃的肾上腺嗜铬细胞瘤主要产生去甲肾上腺素。虽然使用了几种降压药物,但仍发生3次室性心动过速和足尖扭转,每次发生前均有一段血压波动期,并在高血压危象的高峰时爆发。从这个病例中,我们发现当我们无法获得特异性的α -受体阻滞剂如苯氧苄胺或酚妥拉明时,持续静脉输注拉贝他洛尔是唯一有效的药物来保护患者免受高血压危象和室性心动过速的发作。在血压控制良好的情况下,顺利切除了右肾上腺。组织学检查显示肾上腺髓质充满嗜铬细胞瘤细胞。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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