Pheochromocytoma Complicated with Severe Ventricular Tachycardia: Report of One Case

嗜鉻細胞瘤併發嚴重心室性頻脈：一病例報告

黃有志(Yu-Chih Huang) ； 張兆祥(Chao-Hsiang Chang) ； 王仲興(Chung-Hsing Wang) ； 張正成(Jeng-Sheng Chang)

《Acta Paediatrica Taiwanica》 48卷5期 (2007/10) Pp. 280-284

https://doi.org/10.7097/APT.200710.0280

摘要

嗜鉻細胞瘤最常好發的位置是腎上腺髓質的嗜鉻細胞，它會造成高血壓及嚴重的心臟血管問題。如果治療得當，它通常被認爲是一個可以治癒的疾病。嗜鉻細胞瘤的病人通常具有高血壓，頭痛，心悸的病史，而且其高血壓對於口服降血壓藥效果並不好。嗜鉻細胞瘤的診斷通常可以在內分泌檢查或影像檢查後得知。在此，我們報告一位十一歲大的嗜鉻細胞瘤病人，她經歷了嚴重的高血壓，頭痛，心悸等症狀，在住院後即使使用了多種的降血壓藥，病人依然發生多次的高血壓危象，而心室性頻脈以及Torsade de poillt心室頻脈也發生過3次，甚至須要到執行心肺復甦術的情況。從這個病例中我們發現，專一性的α接受器阻斷劑如phenoxybenzamine或phentola-mine在台灣並無法立即取得，在使用靜脈連續性的滴注labetalol，對此位病人而言是唯一可以保護使她避免發生高血壓危象以及心究性心率不整的藥物。在這篇文章中我們主要強調的是嗜鉻細胞瘤在心臟血管方而可對病人造成巨大的衝擊以及在急性發作期正確的診斷以及適當藥物使用的重要性。

關鍵字

嗜鉻細胞瘤 ； 高血壓 ； 心室性頻脈 ； 心肌病變

並列摘要

Pheochromocytoma in children shows much worse complications than that in the adult patients. An 11-year-old girl was transferred to our emergency room after suffering from headache, dizziness, cold sweating and palpitation for 3 days. Severe hypertension, remarkable blood pressure fluctuation between 260/160 and 65/50 mmHg, decrease of cardiac contractility, as well as abnormal electrocardiogram findings including ST-T segment elevation and QT interval prolongation were noted soon after admission. Later, a 4×4.5×2.5 cm tumor in the right adrenal gland area was found by computed axial tomogram study. Assessment of the urine catecholamine metabolites showed high levels of vanillylmandelic acid, normetanephrine and norepinephrine indicating an active adrenal pheochromocytoma produced mainly norepinephrine. Although several antihypertensive drugs were used, ventricular tachycardia and Torsade de pointe still occurred on her for 3 times, each was preceded by a period of blood pressure fluctuation and burst out concomitantly at the peak of a hypertension crisis. From this case, we found that when the specific -blocker like phenoxybenzamine or phentolamine was not available to us, labetalol by continuous intravenous infusion was the only effective drug to protect the patient from attacks of hypertensive crisis and ventricular tachycardia. Her right adrenal gland was resected smoothly when BP was well under control. Histological examination showed the adrenal medulla was full of pheochromocytoma cells.

並列關鍵字

pheochromocytoma ； hypertension ； ventricular tachycardia ； cardiomyopathy