PDF(Pubmed)
Abstract：
Pheochromocytoma rarely presents with unexplained hypokalaemia, although there are some case reports in the literature. The mechanism behind this could be the increased cellular potassium uptake promoted by beta-2-adrenoreceptor hyperactivation and insulin resistance. We present the case of a 68-year-old hypertensive female patient with a unilateral adrenal mass discovered on angio-CT and typical signs of adrenergic hyperstimulation (hypertensive crisis, headache, and sweating) associated with multiple arrhythmic episodes but with normal plasma and urinary catecholamine levels. During the work-up for hormonal hypersecretion and the cessation of anti-aldosterone medication, the patient presented resistant hypokalaemia. Due to uncorrectable hypokalaemia, we were unable to perform hormonal investigations for primary hyperaldosteronism and referred the patient for laparoscopic adrenalectomy. The histological diagnosis revealed left pheochromocytoma. Postoperatively, the patient experienced rebound hyperkalaemia. In a patient with a unilateral adrenal mass and hypokalaemia, besides primary hyperaldosteronism and adrenocorticotropic hormone-independent hypercortisolism, a possible pheochromocytoma should be ruled out as well by the clinician before surgery.
摘要：
嗜铬细胞瘤很少出现原因不明的低钾血症，虽然文献中有一些病例报道。其背后的机制可能是β-2-肾上腺素受体过度激活和胰岛素抵抗促进的细胞钾摄取增加。我们介绍了一名68岁的高血压女性患者的情况，该患者在血管CT上发现了单侧肾上腺肿块，并伴有典型的肾上腺素能过度刺激（高血压危象，头痛,和出汗）与多次心律失常发作有关，但血浆和尿儿茶酚胺水平正常。在激素分泌过多和停止抗醛固酮药物治疗的过程中，患者出现耐药性低钾血症.由于无法纠正的低钾血症，我们无法对原发性醛固酮增多症进行激素检查,并将患者转诊为腹腔镜肾上腺切除术.组织学诊断为左嗜铬细胞瘤。术后,患者出现反弹型高钾血症.在单侧肾上腺肿块和低钾血症的患者中，除了原发性醛固酮增多症和促肾上腺皮质激素依赖性皮质醇增多症，手术前，临床医生也应排除可能的嗜铬细胞瘤。
