22例不典型肾上腺嗜铬细胞瘤的临床分析_《中国循证医学杂志》

作者：

易发现 ¹ , 魏强 ² , 沈宏 ² , 石明 ² , 范天勇 ² , 李响 ² , 李虹 ² , 杨宇如 ² ,  董强 ²

1. 内蒙古医学院附属医院泌尿外科（呼和浩特 010051）；2. 四川大学华西医院泌尿外科（成都 610041）;

关键词：

肾上腺嗜铬细胞瘤去甲肾上腺素肾上腺素

DOI：

10.7507/1672-2531.20090011

视频：

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目的　回顾性分析22例不典型肾上腺嗜铬细胞瘤的临床诊断资料，以提高不典型嗜铬细胞瘤的诊断水平。
方法　纳入1998年～2004年在我院诊治的肾上腺嗜铬细胞瘤患者90例，根据临床表现分为典型组和不典型组，研究不典型嗜铬细胞瘤患者年龄、肿瘤部位、肿瘤最大径、高血压、血浆儿茶酚胺等方面和典型组患者的差异。
结果　 90 例患者中有22 例（24.4%）为不典型肾上腺嗜铬细胞瘤，68 例（75.6%）为典型肾上腺嗜铬细胞瘤。两组患者年龄、肿瘤平均最大径均无显著差异；不典型组肾上腺肿瘤主要位于右侧肾上腺，其去甲肾上腺素浓度显著低于典型组，且不典型组去甲肾上腺素阳性率也明显低于典型组。
结论　本组资料显示，和典型肾上腺嗜铬细胞瘤相比，不典型肾上腺嗜铬细胞瘤主要位于右侧，且血浆去甲肾上腺素的检出率低于前者，从肿瘤大小上无法鉴别出不典型肾上腺嗜铬细胞瘤，但综合患者的临床表现、CT检查、血浆儿茶酚胺检测，大多数不典型嗜铬细胞瘤都可在术前正确诊断。

引用本文： 易发现,魏强,沈宏,石明,范天勇,李响,李虹,杨宇如,董强. 22例不典型肾上腺嗜铬细胞瘤的临床分析. 中国循证医学杂志, 2009, 09(1): 37-40. doi: 10.7507/1672-2531.20090011 复制

1.	Lucon AM, Pereira MAA, Mendonca BB, et al. Pheochromocytoma: Study of 50 cases. J Urol, 1997, 157 (4): 1208-1212.
2.	刘屹立, 徐彪, 孙强, 等. 不典型肾上腺嗜铬细胞瘤. 中华泌尿外科杂志, 2006, 27(11): 725-727.
3.	Dubois LA, Gray DK. Dopamine-secreting pheochromocytomas: in search of a syndrome. World J Surg, 2005, 29(7): 909-913.
4.	Zelinka T, Widimsky J, Weisserova J. Diminished circadian blood pressure rhythm in patients with asymptomatic normotensive pheochromocytoma. Physiol Res, 2001; 50(6): 631-634.
5.	杨绍波, 宫大鑫, 刘贤奎, 等. 肾上腺偶发嗜铬细胞瘤. 中国医科大学学报, 2004, 33(3): 276-277.
6.	van der Harst E, de Herder WW, de Krijger RR, et al. The value of plasma markers for the clinical behaviour of phaeochromocytomas. Eur J Endocrinol, 2002, 147(1): 85-94.
7.	姜元军, 孙志熙, 宫大鑫, 等. 静止型嗜铬细胞瘤和非静止型嗜铬细胞瘤的比较. 临床泌尿外科杂志, 2003, 118(4): 212-213.
8.	Motta-Ramirez GA, Remer EM, Herts BR, et al. Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. Am J Roentgenol, 2005, 185(3): 684-688.
9.	Eisenhofer G, Keiser HR, Friberg P, et al. Plasma metanephrines are markers of phaeochromocytomaproduced by catechol-Omethyltransferase within tumours. J Clin Endocrinol Metab, 1998, 83(6): 2175-2185.
10.	Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab, 2000, 85(2): 637-644.
11.	Proye C, Fossati P, Fontaine P, et al. Dopamine-secreting pheochromocytoma: an unrecognized entity? Classification of pheochromocytomas according to their type of secretion. Surgery, 1986, 100(6): 1154-1162.
12.	Gerlo EAM, Sevens C. Urinary and plasma catecholamines and urinary catecholamine metabolites in phaeochromocytoma: diagnostic value in 19 cases. Clin Chem, 1994, 40(2): 250-256.
13.	Bachmann AW, Hawkins PG, Gordon RD. Phaeochromocytomas secreting adrenaline but not noradrenaline do not cause hypertension and require precise adrenaline measurement for diagnosis. Clin Exp Pharmacol Physiol, 1989, 16(4): 275.
14.	Lipsic E, Balazovjech I, Kosmalova V, et al. Is the secretory pattern decisive for the clinical manifestation? J Endocrinol Invest, 2004, 27: 691-694.
15.	Saginoya T, Miyake H, Kiyosue H, et al. Significance of CT findings and catecholamine determination in peripheral blood of asymptomatic pheochromocytoma and paraganglioma. Nippon Igaku Hoshasen Gakkai Zasshi, 2001, 61: 33-38.
16.	Lenders JW, Pacak K, Eisenhofer G. New advances in the biochemical diagnosis of pheochromocytoma: moving beyond catecholamines. Ann N Y Acad Sci, 2002, 970: 29-40.
17.	Saginoya T, Miyake H, Kiyosue H, et al. Significance of CT findings and catecholamine determination in peripheral blood of asymptomatic pheochromocytoma and paraganglioma. Nippon Igaku Hoshasen Gakkai Zasshi, 2001, 61: 33-38.
18.	Lenders JWM, Pacak K, Walther MM, et al. JAMA, 2002, 287(11): 1427-1434.

1. Lucon AM, Pereira MAA, Mendonca BB, et al. Pheochromocytoma: Study of 50 cases. J Urol, 1997, 157 (4): 1208-1212.
2. 刘屹立, 徐彪, 孙强, 等. 不典型肾上腺嗜铬细胞瘤. 中华泌尿外科杂志, 2006, 27(11): 725-727.
3. Dubois LA, Gray DK. Dopamine-secreting pheochromocytomas: in search of a syndrome. World J Surg, 2005, 29(7): 909-913.
4. Zelinka T, Widimsky J, Weisserova J. Diminished circadian blood pressure rhythm in patients with asymptomatic normotensive pheochromocytoma. Physiol Res, 2001; 50(6): 631-634.
5. 杨绍波, 宫大鑫, 刘贤奎, 等. 肾上腺偶发嗜铬细胞瘤. 中国医科大学学报, 2004, 33(3): 276-277.
6. van der Harst E, de Herder WW, de Krijger RR, et al. The value of plasma markers for the clinical behaviour of phaeochromocytomas. Eur J Endocrinol, 2002, 147(1): 85-94.
7. 姜元军, 孙志熙, 宫大鑫, 等. 静止型嗜铬细胞瘤和非静止型嗜铬细胞瘤的比较. 临床泌尿外科杂志, 2003, 118(4): 212-213.
8. Motta-Ramirez GA, Remer EM, Herts BR, et al. Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. Am J Roentgenol, 2005, 185(3): 684-688.
9. Eisenhofer G, Keiser HR, Friberg P, et al. Plasma metanephrines are markers of phaeochromocytomaproduced by catechol-Omethyltransferase within tumours. J Clin Endocrinol Metab, 1998, 83(6): 2175-2185.
10. Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab, 2000, 85(2): 637-644.
11. Proye C, Fossati P, Fontaine P, et al. Dopamine-secreting pheochromocytoma: an unrecognized entity? Classification of pheochromocytomas according to their type of secretion. Surgery, 1986, 100(6): 1154-1162.
12. Gerlo EAM, Sevens C. Urinary and plasma catecholamines and urinary catecholamine metabolites in phaeochromocytoma: diagnostic value in 19 cases. Clin Chem, 1994, 40(2): 250-256.
13. Bachmann AW, Hawkins PG, Gordon RD. Phaeochromocytomas secreting adrenaline but not noradrenaline do not cause hypertension and require precise adrenaline measurement for diagnosis. Clin Exp Pharmacol Physiol, 1989, 16(4): 275.
14. Lipsic E, Balazovjech I, Kosmalova V, et al. Is the secretory pattern decisive for the clinical manifestation? J Endocrinol Invest, 2004, 27: 691-694.
15. Saginoya T, Miyake H, Kiyosue H, et al. Significance of CT findings and catecholamine determination in peripheral blood of asymptomatic pheochromocytoma and paraganglioma. Nippon Igaku Hoshasen Gakkai Zasshi, 2001, 61: 33-38.
16. Lenders JW, Pacak K, Eisenhofer G. New advances in the biochemical diagnosis of pheochromocytoma: moving beyond catecholamines. Ann N Y Acad Sci, 2002, 970: 29-40.
17. Saginoya T, Miyake H, Kiyosue H, et al. Significance of CT findings and catecholamine determination in peripheral blood of asymptomatic pheochromocytoma and paraganglioma. Nippon Igaku Hoshasen Gakkai Zasshi, 2001, 61: 33-38.
18. Lenders JWM, Pacak K, Walther MM, et al. JAMA, 2002, 287(11): 1427-1434.

《中国循证医学杂志》

22例不典型肾上腺嗜铬细胞瘤的临床分析

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《中国循证医学杂志》

22例不典型肾上腺嗜铬细胞瘤的临床分析

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