血皮质醇高为表现的肾上腺嗜铬细胞瘤

High Serum Cortisol as the Presenting Manifestation of Pheochromocytoma

目的:探讨肾上腺嗜铬细胞瘤并血皮质醇升高的临床特点和诊治方法。方法:回顾分析3例肾上腺嗜铬细胞瘤并并血皮质醇升高病例资料。结果:3例均有高血压、高血糖。尿VAM轻微升高,而血浆肾素、血管紧张素活性均正常。经B超、CT均诊断为肾上腺肿瘤,行患侧肾上腺切除术,术后血糖恢复正常,高血压消失或明显缓解。病理诊断为嗜铬细胞瘤。结论:肾上腺嗜铬细胞瘤并发皮质醇症均有不同程度的皮质醇症表现,部分病例同时有儿茶酚胺症的特点,综合分析临床资料可能在术前作出诊断,围手术期应按儿茶酚胺症处理,确诊需病理检查。

Objective：To study the clinical features,diagnostic and treatment of pheochromocytoma with high serum cortisol as manifestation.Method：The clinical data of three cases were retrospectively analyzed.Result：All the 3 cases had hypertension and hyperglycemia.The serum cortisol were high.But the plasma renin and angiotensin Ⅱ activity were normal and urinary catecholamine and its metabolites were lightly increased.The adrenal tumor were revealed on ultrasonography,CT scan.The size of the tumors was 1.0 to 5.5 cm in diameter.Resection of the involved adrenal gland was performed in all the patients.After operation,the glucose level became normal with hypertension disappeared or significantly relieved.Pathology studies revealed pheochromocytoma.Conclusion：High serum cortisol can be seen in all three cases and features of pheochromocytoma can be found in some of the cases.Preoperative diagnosis may be assessed if the clinical data is comprehensively analyzed.Perioperative management should be the same as in pheochromocytoma.The final diagnosis dependents on pathologic studies.