| Objective:To improve the diagnosis and therapy of pheochromocytoma by analyzing retrospectively the clinical data of 28 cases of pheochromocytoma. Method: Clinical data of 28 cases of pheochromocytoma in our hospital from 1997 to 2004 were collected. 18 patients were confirmed as pheochromocytoma by surgical operation and pathology and 10 patients were confirmed by clinical analysis. The characters of clinical symptoms, chemicobiology and imaging of pheochromocytoma were summarized through collection and statistic analysis of the material of these patient's clinical appearance, laboratory examination and pharmacological test. Result: (1) These 28 patients included 10 males, 18 females, 19 Hans, 7 Uigurs and 2 Kazakans. The cases were at ages from 9 to 68 yr with a mean age of (40.68±15.33) yr. The course of disease was 3 months to 10 years with the mean of (3.56±2.7)yr. (2) The blood pressure fluctuated acutely in 85.7% patients. In 17 patients of paroxysmal hypertension, the average fluctuated range was (78.82±32.66) mmHg in systolic blood pressure and (43.94±15.98) mmHg in diastolic blood pressure. In 7 patients of persistent hypertension together with blood pressure increased paroxysmally, the average fluctuated range of systolic blood pressure was (89.29±39.84)mmHg and of diastolic blood pressure was (62.86±26.90)mmHg. 4 patients had persistent hypertension. The average systolic blood pressure was (167.75±16.64)mmHg and the average diastolic blood pressure was (101.25±9.46)mmHg. The typical symptoms of headache palpitation, diaphoresis were found in 35.7% patients and any two of these three symptoms were found in 32.1% patients. (3) Of 28 cases, the tumors in the adrenal gland were seen in 18 patients, the externadrenal gland in 10 patients which distributed in the sides of abdominal aorta, bladder, the lower pole of kidney, ahead of the upper pole of kidney and the sides of rightiliac artery. The longest diameter of tumor ranged 9 ~80 mm, the average was (40.57± 18.11 )mm. (4) 64.3% patients were affected by dyslipidemia. Mixed hyperlipidemia were the major types of dyslipidemia. 3 patients achieved diagnostic criteria of diabete, 2 patients achieved diagnostic criteria of impaired glucose tolerance.2 patients combined with hypokalemia. The plasma renin activity was measured in 16 patients and increased in 25.0% patients. The supine and erect serum aldosterone was measured in 22 patients and increased in 68.2% and 36.4% patients. 24h Urinary VMA were measured in 18 patients and the positive rate was 27.8%. 4h Urinary VMA of paroxysm were measured in 8 patients and the positive rate is 62.5%. The positive rate of 4h Urinary VMA was higher than 24h Urinary VMA, but had not statistic difference. (5) Echocardiography was performed in 17 cases and left ventricular hypertrophy was confirmed in 10 cases. 6 cases combined with renal impairement. 3 cases combined with celebrovascular disease. (6) The veracity of orientation of B ultrasonography, CT and MR were 60.0%, 92.8%. 100% respectively. 6 patients were evaluated by I31I-MIBG scintigraphy and 83.3% patients were positive. Conclusion: Pheochromocytoma often presents the clinical syndrome of hypertension. The clinical appearance of pheochromocytoma is complicated and lacking in specificity, together with the tumor secretes a great deal of catecholamine which result in abnormality in blood glucose, blood lipid and many kind of hormone, so pheochromocytoma is easily diagnosed mistakenly as essential hypertension or essential hypertension combined with diabetes or dyslipidemia. To the suspected patients, the quality and orientation diagnosis of pheochromocytoma should be decided by measuring the concentration of urinary VMA, especially at the time of paroxysm and by taking CT, MR and 131I-MIBG imaging, which can get the aim of early diagnosis and therapy and prevent serious complication caused by this serious but can be cured "hypertension". |
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