A Patient with Pheochromocytoma Showing Periodic Fluctuations of Blood Pressure and Electrocardiographic Abnormalities Mimicking Acute Coronary Syndrome

一名心電圖異常類似急性冠心症的嗜鉻細胞瘤患者及其血壓週期性波動

許振東(Chen-Tung Hsu) ； 陳澄鋆(Cheng-Yun Chen)

《中華民國急救加護醫學會雜誌》 20卷1期 (2009/03) Pp. 25-32

https://doi.org/10.30018/JECCM.200903.0003

摘要

一名四十八歲的婦女由於胸痛、盜汗、嘔吐和心悸而住院。心電圖顯示有急性冠心症。但是，緊急冠狀動脈攝影檢查結果正常。血壓週期性波動讓我們臨床懷疑為嗜鉻細胞瘤。隨後電腦斷層掃瞄發現一顆左腎上腺腫瘤（8.5×8×6公分）。24小時尿液檢查發現vanillylmandelic acid (VMA)和兒茶酚胺過高，進一步支持了嗜鉻細胞瘤的診斷。經過交感神經阻斷劑的治療後，再追蹤心電圖，顯示心肌缺氧的異常幾乎恢復正常。經由左腎上腺切除術以後，患者主訴的症狀、糖尿病和高血壓完全消失。這個病例說明嗜鉻細胞瘤應該被包含在急性冠心症的鑑別診斷中。

關鍵字

血壓 ； 胸痛 ； 糖尿病 ； 心電圖 ； 嗜鉻細胞瘤

並列摘要

A forty-eight-year-old woman was admitted because of substernal chest pain, profuse diaphoresis, vomiting and palpitation. Electrocardiography suggested acute coronary syndrome. However, the emergency coronary angiographic findings were normal. Periodic fluctuations in her blood pressure raised a clinical suspicion of pheochromocytoma. A subsequent computed tomography scan revealed a single left adrenal mass (8.5×8×6cm). Elevated 24-hour urine levels of vanillylmandelic acid and catecholamines supported the diagnosis of pheochromocytoma. After therapy with adrenergic blockade, a repeat ECG revealed near complete resolution of the ischemic changes. Her symptoms, diabetes and hypertension resolved after a left adrenalectomy. This case illustrates that pheochromocytoma should be included in the differential diagnosis of acute coronary syndrome.

並列關鍵字

blood pressure ； chest pain ； diabetes mellitus ； electrocardiography ； pheochromocytoma