警惕嗜铬细胞瘤所致神经系统损害(附20例报告)

Alertness to Nervous System Damage Caused by Pheochromocytoma(Misdiagnosis Analysis of 20 Cases)

目的探讨嗜铬细胞瘤致神经系统损害的临床特点,以减少误诊误治。方法对2005年1月—2015年1月收治并误诊的嗜铬细胞瘤20例的临床资料进行回顾性分析。结果本组20例均有长期高血压病史,常规口服降压药物治疗效果不佳,主要表现为头晕、头痛、呕吐、行走不稳、乏力、抽搐、意识障碍、肢体偏瘫及麻木,反复到神经内科就诊,误诊为脑血管供血不足9例,癫痫5例,脑炎、急性脑梗死各2例,良性颅高压、脑出血各1例。后分别经B超、CT、MRI检查,血儿茶酚胺、24 h尿香草基苦杏仁酸检测及手术病理确诊为良性嗜铬细胞瘤,病灶位于肾上腺19例,膀胱1例。17例术后血压恢复正常,3例血压仍偏高,予钙离子拮抗剂降压,血压控制良好。结论临床对常规降压药治疗无效的高血压、阵发性高血压且伴神经系统损害表现者,应高度警惕嗜铬细胞瘤可能,及时行血儿茶酚胺、24 h尿香草基苦杏仁酸检测及相关影像学检查是避免误诊的关键。

Objective To investigate the clinical characteristics of nervous system damage caused by the pheochromocytoma in order to reduce misdiagnosis and mistreatment rates. Methods We retrospectively analyzed clinical data of 20 misdiagnosed cases with pheochromocytoma during January 2005 and January 2015. Results 20 patients had hypertension for a long time and the effect of the conventional antihypertensive medication was poor. The main symptoms were dizziness,headache,vomiting,walking instability,lack of power,convulsions,disturbance of consciousness,limb hemiplegia and numbness. After visits to neurology department,9 cases were misdiagnosed as cerebral blood supply insufficiency,5 cases of epilepsy,2 cases of encephalitis,1 case of benign intracranial hypertension,2 cases complicated with acute cerebral infarction,and 1 case with cerebral hemorrhage,all of which respectively underwent ultrasound,CT and MRI examinations and blood catecholamine,24-hour urine vanilla bitter almond acid detection. Histopathological results showed that all the cases were benign pheochromocytoma,adrenal with 19 cases of,and 1 case of bladder. 17 cases of postoperative blood pressure returned to normal,3 cases of blood pressure was still on the high side to CCB class step-down,and blood pressure was well controlled.Conclusion Neural physicians should be alert to nervous system damage caused by pheochromocytoma. For invalid conventional antihypertensive drug treatment,paroxysmal hypertension and nervous system damage,physicians should be more vigilant about pheochromocytoma. Urinary tract imaging examination and blood catecholamine,24-hour urine vanilla base of bitter almond acid test are essential in avoiding misdiagnosis.