急性心力衰竭,偶然发现肾上腺囊性肿块。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Salman Zahoor Bhat, Amir H Hamrahian, Yubo Wu, Misop Han, Roberto Salvatori
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引用次数: 0

摘要

摘要:嗜铬细胞瘤是一种罕见的肾上腺肿瘤,其特征是儿茶酚胺分泌过多。与嗜铬细胞瘤相关的症状和体征通常是间歇性和慢性的,但很少会发展成危及生命的危机。我们描述了一例先前健康的女性急性严重充血性心力衰竭,通过急性药物治疗,她迅速康复(入院后4天)。评估的病因是先前未诊断的嗜铬细胞瘤的自发性出血,导致嗜铬细胞癌危象和短暂性应激性心肌病,随后心脏功能迅速恢复。我们的目的是将嗜铬细胞瘤描述为一种罕见的应激性心肌病病因。我们讨论了危重症期间对嗜铬细胞瘤的评估,以及嗜铬细胞癌危象的触发因素/治疗策略。学习要点:嗜铬细胞瘤出血可导致嗜铬细胞癌危象,过量儿茶酚胺的突然释放会导致多系统器官功能障碍和高死亡率。在没有心脏危险因素的患者中,急性失代偿性心力衰竭可能是嗜铬细胞瘤的罕见表现。急性应激临床情况下的后肾测量可能与嗜铬细胞瘤的生化图像有相当大的重叠。早期影像学研究可能有助于鉴别诊断。在进行肾上腺活检之前,应排除嗜铬细胞瘤。嗜铬细胞瘤危象的紧急肾上腺切除术导致高死亡率。α阻断后选择性肾上腺切除术后急性危象的医学治疗效果更好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Acute heart failure with incidentally found cystic adrenal mass.

Acute heart failure with incidentally found cystic adrenal mass.

Acute heart failure with incidentally found cystic adrenal mass.

Acute heart failure with incidentally found cystic adrenal mass.

Summary: Pheochromocytomas are rare adrenal tumors characterized by excessive catecholamine secretion. Symptoms and signs associated with pheochromocytomas are usually intermittent and chronic but can rarely develop into life-threatening crises. We describe a case of acute severe congestive heart failure in a previously healthy female, who recovered rapidly (4 days after admission) with acute medical therapy. The etiology on evaluation was a spontaneous bleed in a previously undiagnosed pheochromocytoma, resulting in a pheochromocytoma crisis and transient stress cardiomyopathy, followed by quick recovery of cardiac function. Our aim is to describe pheochromocytoma as a rare cause of stress cardiomyopathy. We discuss the evaluation of pheochromocytoma during critical illness and triggers/treatment strategies for pheochromocytoma crises.

Learning points: Hemorrhage in a pheochromocytoma can result in a pheochromocytoma crisis, with sudden release of excess catecholamines resulting in multisystem organ dysfunction and high mortality. Acute decompensated heart failure can be a rare presentation of pheochromocytoma, in a patient with no cardiac risk factors. Measurement of metanephrines in acutely stressful clinical situations can have considerable overlap with the biochemical picture of pheochromocytoma. Early imaging studies may help with the differential diagnosis. Pheochromocytoma should be ruled out before performing an adrenal biopsy. Emergent adrenalectomy in pheochromocytoma crisis results in high mortality. Medical management of the acute crisis followed by elective adrenalectomy after alpha-blockade results in better outcomes.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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