不典型肾上腺嗜铬细胞瘤

Atypical adrenal pheochromocytoma

目的总结对不典型嗜铬细胞瘤的诊断和治疗效果。方法无症状肾上腺嗜铬细胞瘤28例,均无高血压病史,内分泌功能检查仅3例尿儿茶酚胺(CA)和尿3-甲基-4-羟基苦杏仁酸(VMA)水平轻度增高。21例肿瘤>3 cm者增强CT均可见肿瘤周边强化明显,内部有不均匀强化,个别可见偏心液化;7例肿瘤≤3 cm者周边与内部强化较均匀一致。根据影像学检查拟诊为不典型嗜铬细胞瘤,2001年以前收治的12例术前未给予降压药和扩容准备;其后收治的16例术前3 d每晚给予多沙唑嗪缓释片4 mg,术晨加服4 mg进行药物准备,不扩容。结果28例均行开放性肾上腺肿瘤切除术,术中血压波动14例,其中术前未服用多沙唑嗪缓释片组3例出现高血压危象,服用多沙唑嗪缓释片组无高血压危象。术后诊断隐匿型嗜铬细胞瘤14例,无功能嗜铬细胞瘤14例。结论不典型嗜铬细胞瘤特别是隐匿型嗜铬细胞瘤应引起泌尿外科医生足够重视。术前应用缓释型α受体阻滞剂对于保证术中血压的平稳具有很好的应用价值。

Objective To improve the diagnostic accuracy and therapeutic effects of atypical adrenal pheochromocytoma. Methods From 1980 to 2003,28 patients with asymptomatic suprarenoma were diagnosed as atypical pheochromocytoma based on imaging study, All patients had no previous hypertension. Endocrine examination showed slight increase in urine catecholamine（CA） and vanillylmandelic acid（VMA） levels in only 3 of the 28 patients. Cardura （ doxazosin mesylate controlled release tablet） was given to 16 patients who were treated after 2001 for 3 days before operation. Results Open adrenalectomy was performed on all 28 patients. During operation 14 patients had blood pressure elevation. Three patients who were not given cardura had hypertensive crisis ; while in cardura group, slight rise of blood pressure occurred in 6 patients and no hypertensive crisis occurred. Postoperative diagnosis was latent pheochromocytoma in 14 cases and nonfunctioning pheochromocytoma in another 14 cases. Conclusions For urologists, more attention should be paid to atypical pheochromocytoma, especially latent pheochromocytoma. Preoperative use of α - blocker may play an important role in controlling rapid rise in blood pressure due to large amount of adrenaline released by pheochromocytoma.