Retrospective Analysis Of Pheochromocytoma Patients With Clinical Cardiovascular Manifestations

Objective: A retrospective analysis of previous clinical manifestations treated adrenal pheochromocytoma cases, especially cardiovascular injury, diagnosis, treatment and prognosis, the adrenal pheochromocytoma make a summary of the clinical features of pheochromocytoma heart conditions and cardiovascular damage in patients to make a statistical analysis. Patients with cardiovascular damage depth carding hoping to provide a reference for future clinical diagnosis and treatment and prevention of cardiovascular damage.Methods: Derived from July 2010 to July 2015, the Second Hospital of Tianjin Medical University, collected and Tianjin port hospital discharge diagnosis of pheochromocytoma of discharged patients, a total of 80 cases. Male 55 patients, 25 cases of female patients; age distribution of patients from 15 to 80 years(50.11 ± 1.58 years), duration period of 1 day to 30 years. The study collected and discharged the patient's age, sex, "headache, palpitations, sweating," the incidence of pheochromocytoma typical triad of chest pain and whether hypertension clinical symptoms were recorded myocardial enzymes, blood sugar, blood lipids, blood, blood catecholamines and urinary catecholamines, electrolytes, liver and kidney function tests and electrocardiogram changes and other test results, as well as clinical data for treatment process and treatment and so on. Using ultrasound, CT and MRI to locate pheochromocytoma diagnosis, pathological diagnosis using qualitative diagnosis. Also collected between July 2010 to July 2015 80 patients with essential hypertension in general. Male 50 patients, 30 cases of female patients; age distribution of 17-75 years(49.30 ± 3.81 years). While collecting the patient's age, sex and other demographic information, as well as whether there are clinical symptoms of chest pain and hypertension, and myocardial enzymes were recorded, blood, blood sugar, blood lipids, blood catecholamines, urinary catecholamines, electrolytes, liver and kidney function tests and electrocardiogram test results, etc., treatment processes and treatment and other information.Results:(1)80 cases of pheochromocytoma patients study collected, mainly for pheochromocytoma triad "palpitations, sweating, headache," one of the patients was 56 cases(70.00%), admission, clinical manifestations, chest tightness 20 cases(25.00%), chest pain in 5 cases(6.25%), dizziness in 30 cases(37.50%), different tumor location: right adrenal tumors in 42 cases, the left side in 31 cases, bilateral in 3 cases, retroperitoneal tumor in 2 cases, after the merger left adrenal retroperitoneal tumor in 2 cases. All 71 patients underwent tumor resection, pathology showed, pheochromocytoma, 65 cases of benign and malignant six cases. Tumor associated with 62 cases(77.5%) of patients with hypertension, patients with hypotension 4 cases(5.00%), 2 cases(2.50%) in patients with acute left heart failure, patients with coronary heart disease in 5 patients(6.25 %), the diagnosis of patients with catecholamine cardiomyopathy 2 cases(2.50%), patients with cerebrovascular accident in 3 cases(3.75%).(2) 80 cases of pheochromocytoma patients, 72 patients had a history of hypertension, which develop in patients with paroxysmal increase sustained hypertension with 13 cases, seizure frequency: light bout 2-3 months, severe frequent seizures; high blood pressure, up to 200-300 / 140-160 mm Hg, and the use of antihypertensive drug therapy in general; longer duration of about 1 day-30 years. Hypertensive patients 3 patients presented with acute cerebrovascular accident; 2 patients at the onset of hypertension orthostatic hypotension occurred in the absence untreated; one cases first diagnosed as hypertensive crisis, and was rapidly progressive, with sharp deterioration of renal function. Patients with hypertension in the majority of clinical manifestations of sweating, severe headache, have stroke movement, and the average age of patients is not associated with higher blood pressure.(3) catecholamine cardiomyopathy patients, 2 patients, which showed left ventricular failure in patients with acute recurrent one case, attack the main manifestations of acute pulmonary edema, to support rapid regression of lung disease after treatment. Coronary angiography showed one patient with acute myocardial infarction clearly occur. Most patients have one of pheochromocytoma triad(headache, palpitations, sweating) performance with ECG abnormalities(S-T wave changes, T wave inversion, left ventricular high voltage). Pheochromocytoma combined heart damage shown in Table 3. In order to investigate whether the catecholamines for hemodynamic outside independent cardiac toxic effects, this study whether left ventricular hypertrophy in hypertensive patients were divided into two groups, age, and gender differences in BMI between the two groups of patients was not statistically significant( P> 0.05) between the two groups were compared daily systolic blood pressure, diastolic blood pressure, hypertension, blood pressure and time expressions(continuous and burst) were not significantly different(P> 0.05). 24 h urinary norepinephrine, heart rate and left ventricular hypertrophy in hypertensive patients is higher than the non-adrenaline left ventricular hypertrophy(P <0.05)(4) In this study, the patients underwent ultrasound examination of 70 cases, including pheochromocytoma sites of tumor cells from patients with the correct positioning of the 69 cases, the positive rate was 98% more performance for, echogenic mass, cystic or solid hypoechoic mass. The patients underwent CT, 68 cases of pheochromocytoma occurring site in the correct orientation was 100% more performance for uniform low density. MRI examination of patients with 20 cases of pheochromocytoma occurring site in the correct orientation was 100%.(5) This retrospective study also collected 80 cases of clinical data of patients with essential hypertension, the average age was 49.30 ± 3.81 years, pheochromocytoma in hypertensive patients addicted to correspond, headache patients with essential hypertension, 30 cases( 37.5%), sweating in 11 patients(13.75%), palpitations 10 cases(12.25%), while triad 10 cases(12.5%). Chest 10 cases(12.5%), chest pain, 6 patients(7.5%), dizziness in 26 cases(32.5%), nausea and vomiting in 11 patients(13.75%), 0 cases of acute heart failure, coronary heart disease in 2 cases(2.5 %), catecholamine cardiomyopathy 0 cases, four cases of cerebral vascular accident(5%), sinus tachycardia in 11 cases. In comparison discriminating triad, heart damage, etc., the difference was statistically significant(P <0.05)Conclusion : Pheochromocytoma can cause a variety of life-threatening cardiovascular disease, including myocardial infarction, hypertensive emergency, shock and multi-system failure. If the disease is not properly identified or appropriate treatment, it will inevitably lead to fatal complications. The study found that patients with pheochromocytoma more common symptoms of cardiovascular damage in patients with hypertension as the main performance, but also the patients showed hypotension. Patients with hypertension because the body can be a sharp rise in blood pressure, can cause other serious complications, such as heart failure, cerebral hemorrhage, renal failure and other complications, great harm to the body and even life-threatening. There are also other arrhythmia, myocardial ischemia, acute left ventricular failure, catecholamine cardiomyopathy myocardial damage performance. Since pheochromocytoma diversity of clinical manifestations, first diagnosed in multiple clinical departments of the emergency department, cardiology, nephrology, neurology, endocrinology, etc. are likely to find that in clinical work should pay attention to the need to identify this disease, with advances in cancer diagnosis and localization technology, doctors may have the ability to more quickly and reliably make the diagnosis of pheochromocytoma. There are traces of pheochromocytoma should give due consideration to tumor screening. Reduce the confusion caused by misdiagnosis of disease, early diagnosis and proper treatment can significantly reduce morbidity and mortality and reduce the burden of disease in patients.