腎上腺嗜鉻細胞瘤以醛固酮增多及次發性高血壓表現: 病例報告與文獻回顧

王柏仁^1,2、易志成^1,2、李建達^1,2

¹國軍台中總醫院 外科部 泌尿科

²國防醫學院 醫學系

A case of adrenal pheochromocytoma presenting as hyperaldosteronism and secondary hypertension: case report and literature review

Bo-Ren, Wang^1,2、Chin-Cheng, Yi^1,2、Jane-Dar, Lee^1,2

¹Division of Urology, Department of surgery, Taichung Armed Forces General Hospital

²National Defense Medical Center

Introduction

Pheochromocytoma is a rare catecholamine-releasing tumor which is progressed from chromaffin cells derived from the neural crest. The annual incidence is around 2–8 per million population. The famous 10% rule (10% extra-adrenal,10% familial,10% bilateral,10% pediatric,10% malignant) was proposed by John Graham in 1951 to describe the characteristic of the pheochromocytoma. Most pheochromocytoma (80-90%) is in the adrenal gland and the others is distributed in the paravertebral and para-aortic axis called paraganglioma. The clinical presentation symptoms of the pheochromocytoma are headache (50%), sweating (50%), palpitation (50-60%), hypertension (60%) caused from hormone excess. Here, we presented an interesting case of adrenal pheochromocytoma presenting as hyperaldosteronism and secondary hypertension

Case presentation

A 54-year-old female with the chief complaint of hypertension and severe headache came to our hospital for help. She received regular follow-up in CV OPD under multiple antihypertensive drugs but the effect was not significant. Due to poor control of the blood pressure, we surveyed the possible reason for the situation and high aldosterone with normal renin level was accidentally found.  Besides, the catecholamine in 24H-urine and VMA were in normal range. CT was arranged and one 1.5cm soft tissue nodule was noted in the right adrenal gland. Adrenal tumor induced secondary hypertension was considered.

Right laparoscopic adrenalectomy was arranged and the pathologic report revealed that it was a pheochromocytoma. After the operation, her symptoms were relieved and the level of aldosterone was gradually normal.

In the whole hospital course, we were interested of the atypical biochemistry presentation of the pheochromocytoma and discussed about the cause of the result.

Conclusion:

  Pheochromocytoma was account 0.2-0.4% in hypertensive patients. It would induce hypertensive crisis or cardiovascular disease if the disease was not diagnosed immediately. Pheochromocytoma typically presented with not only catecholamine excess but also other hormone release. Hence, various result would be found in the biochemistry test. In conclusion, an adrenal gland tumor with hyperaldosteronism, we still must keep in mind the differential diagnosis including pheochromocytoma.