嗜铬细胞瘤是肾上腺髓质中产生儿茶酚胺的肿瘤,通常伴有高血压,高血糖症,代谢亢进,头痛,和多汗症,分为良性和恶性嗜铬细胞瘤。此外,在恶性嗜铬细胞瘤患者中经常观察到持续性高血压。
一名52岁的日本男性在我们机构转诊并住院。他每年都进行健康检查,没有发现异常。此外,他没有高血压病史。在内分泌学标志物中,去甲肾上腺素水平高达7693pg/ml,而肾上腺素水平在正常范围内。腹部对比增强计算机断层扫描显示右肾上腺有一个50毫米的超血管化肿瘤伴钙化,肝脏中有多个超血管化肿瘤。在131IMIBG闪烁显像中,右肾上腺有大量积累,肝脏和骨骼有多个积累。在超声心动图中,左心室射血分数低至14.3%。在冠状动脉造影中,然而,冠状动脉无明显狭窄.基于这些发现,我们最终诊断为恶性嗜铬细胞瘤并伴有多发性肝骨转移和儿茶酚胺心肌病。然而,在没有任何抗高血压药物的情况下,血压持续在正常范围内.右肾上腺肿瘤切除术与左肝叶切除术和胆囊切除术一起进行。此外,术前血清血管内皮生长因子(VEGF)和甲状旁腺(PTH)相关蛋白水平很高,但术后明显下降。
这是第一份报告显示恶性嗜铬细胞瘤患者血清VEGF水平的时程,清楚显示恶性嗜铬细胞瘤实际上分泌VEGF。此外,这份病例报告清楚地表明,我们应该再次记住恶性嗜铬细胞瘤不一定伴有高血压。
Pheochromocytoma is a catecholamine-producing tumor in the adrenal medulla and is often accompanied by hypertension, hyperglycemia, hypermetabolism, headache, and hyperhidrosis, and it is classified as benign and malignant pheochromocytoma. In addition, persistent hypertension is often observed in subjects with malignant pheochromocytoma.
A 52-year-old Japanese male was referred and hospitalized in our institution. He had a health check every year and no abnormalities had been pointed out. In addition, he had no past history of hypertension. In endocrinology markers, noradrenaline level was as high as 7,693 pg/ml, whereas adrenaline level was within normal range. Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver and bone. In echocardiography, left ventricular ejection fraction was as low as 14.3%. In coronary angiography, however, there was no significant stenosis in the coronary arteries. Based on these findings, we finally diagnosed him as malignant pheochromocytoma accompanied by multiple liver and bone metastases and catecholamine cardiomyopathy. However, blood pressure was continuously within normal range without any anti-hypertensive drugs. Right adrenal tumor resection was performed together with left hepatic lobectomy and cholecystectomy. Furthermore, serum levels of vascular endothelial growth factor (VEGF) and parathyroid (PTH)-related protein were very high before the operation but they were markedly reduced after the operation.
This is the first report showing the time course of serum VEGF level in a subject with malignant pheochromocytoma, clearly showing that malignant pheochromocytoma actually secreted VEGF. In addition, this case report clearly shows that we should bear in mind once again that malignant pheochromocytoma is not necessarily accompanied by hypertension.