嗜鉻細胞瘤快速進展的症兆-罕見病例報告

李定廉、蔡禮賢

中國醫藥大學附設醫院 泌尿部

The signs of rapid progression of pheochromocytoma: a case report

Ting-Lien Li, Li-Hsien Tsai

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Background

Pheochromocytomas are a rare type of tumor originating from the chromaffin cells of the adrenal medulla that produce catecholamines. Pheochromocytoma sometimes may be life threatening if the tumor rapid progress and not treated. We will present a case with rapid progression of pheochromocytoma.

Case presentation

A 50-year-old male, presented to the local medical department with severe hypertension for 2 years, with a systolic blood pressure around 220 mmHg and tachycardia. The patient was advised to undergo a CT scan, which revealed a left suprarenal tumor around 10cm. However, the patient was kept under observation at that time. Four months later, the patient complained of sudden left abdominal pain and visited the local medical department again, and a CT scan was performed, which revealed that the left suprarenal tumor had progressed to 11cm. The patient was referred to our emergency department, and the endocrine survey showed elevated levels of Vanillyle-mandelic-acid(VMA): 18.26 mg/24hr (normal, 1 to 7.5 mg/24hr), Aldosterone: 10.42 ng/dL (normal, 4.83-27.0 ng/dL), PRA: 17.97 ng/mL/hr(normal, 0.32-1.84 ng/mL/hr), ARR: 0.58 ng/dL per ng/mL/hour (normal, <30), ACTH: 54.8 pg/mL (normal, <46 pg/mL), and cortisol levels were 22.53ug/dL. The patient was admitted first for hypertension control under a pure Nicardipine pump initially. The cardiology team was consulted and suggested the following medications: Doxaben 4mg qd, Carvedilol 25mg bid, and Sevikar 5/40mg qd. However, the patient came to the emergency department again after discharge for 2 weeks due to right upper quadrant pain for one day, and there were no abnormal lab data at that time. After 2 months of hypertension medical control, the patient was admitted for scheduled surgery and pre-operative evaluation. A CT scan was performed, which revealed a 13 cm mass with a cystic part in the left adrenal gland, with left renal venous invasion, compatible with adrenal gland cancer or pheochromocytoma. Thus, left radical nephrectomy with adrenectomy and IVC thrombectomy was done, and the pathology report revealed malignant pheochromocytoma with extensive local invasion.

Conclusion

In conclusion, this case highlights that abdominal pain on the contralateral side of the tumor may be a hint of the tumor's rapid progression. It may help to recheck the patient's imaging to decide whether to perform surgical intervention or not. Early diagnosis and timely management are crucial for improving patient outcomes.