嗜铬细胞瘤:复杂的心血管表现

Andreea Timofte, Mirela Claudia Nechita, Alexandru-Dan Costache, Silvia Chiriac, Ovidiu Mitu, Florin Mitu, Voichiţa Mogoș, Irina-Iuliana Costache
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摘要

摘要:我们报告一例60岁女性患者,血脂异常、肥胖、糖尿病和高血压,有右肾上腺嗜铬细胞瘤切除史(1999年-没有后续手术或内分泌重新评估),表现为血压值升高和症状复发(头痛、心悸、出汗),并在最近几个月逐渐加重。患者将右肋椎角疼痛与体重减轻联系起来。临床检查表现为面部红肿、多汗、心音过速、血压升高、体位性低血压。心电图显示窦性心动过速,左心室肥厚征象,复极异常,经胸超声心动图证实。腹部和骨盆超声显示在右肾上腺和肝结节的水平有一个大的肿瘤形成。在这些症状的背景下,怀疑嗜铬细胞瘤复发,通过尿去甲肾上腺素增加和影像学方法(腹部和骨盆CT扫描)的生化证实,患者有根治性手术治疗的指征。在完成术前评估(心电图动态动态监测,ABPM)后,住院期间联合4种降压药物调整降压方案,对体位性低血压发作给予糖皮质激素和体积补充胶体液处理。患者被转介到普外科诊所,按照降压准备方案切除肿瘤。虽然术后进展良好,但患者肿瘤复发的风险很高,需要每年进行一次评估,为期10年。此外,由于心血管危险因素与靶器官损伤相关,患者需要定期进行心脏病学评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pheochromocytoma: Intricate Cardiovascular Manifestations
Abstract We present the case of a 60-year-old female patient, dyslipidemic, obese, diabetic and hypertensive, with a history of resected right adrenal pheochromocytoma (1999 - no subsequent surgical or endocrinological re-evaluation), presenting for increased blood pressure values and the recurrence of symptoms (headaches, palpitations, sweating), with progressive accentuation in the last months. The patient associates pain in the right costovertebral angle and weight loss. The clinical examination revealed facial erythrosis, excessive sweating, tachycardic heart sounds, increased blood pressure and orthostatic hypotension. Electrocardiography reveals sinus tachycardia, signs of left ventricular hypertrophy, with repolarization abnormalities, morphological aspect confirmed by the transthoracic echocardiography. An ultrasound of the abdomen and pelvis ultrasound objectified a large tumor formation at the level of the right adrenal gland and a liver nodule. In the context of the symptoms, the suspicion of recurrent pheochromocytoma was raised, confirmed biochemically by the increase in urinary normetanephrines and through imagistic methods (CT scan of the abdomen and pelvis), the patient having an indication for curative surgical treatment. After completing the preoperative assessment (ECG Holter monitor, ABPM), during the hospitalization period, the antihypertensive regimen was adjusted by combining 4 antihypertensive drugs, episodes of orthostatic hypotension being managed by administering glucocorticoids and colloidal solutions for volume repletion. The patient was referred to the general surgery clinic for resection of the tumor, following the antihypertensive preparation protocol. Although the post-procedural evolution was favorable, the patient presents a high risk of tumor recurrence, requiring annual evaluation for a period of 10 years. Also, due to the association of cardiovascular risk factors and target organ damage, the patient requires periodic cardiological evaluation.
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