22例不典型腎上腺嗜鉻細胞瘤的臨床分析_《中國循證醫學雜志》

作者：

易發現 ¹ , 魏強 ² , 沈宏 ² , 石明 ² , 范天勇 ² , 李響 ² , 李虹 ² , 楊宇如 ² ,  董強 ²

1. 內蒙古醫學院附屬醫院泌尿外科（呼和浩特 010051）；2. 四川大學華西醫院泌尿外科（成都 610041）;

關鍵詞：

腎上腺嗜鉻細胞瘤去甲腎上腺素腎上腺素

DOI：

10.7507/1672-2531.20090011

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目的　回顧性分析22例不典型腎上腺嗜鉻細胞瘤的臨床診斷資料，以提高不典型嗜鉻細胞瘤的診斷水平。
方法　納入1998年～2004年在我院診治的腎上腺嗜鉻細胞瘤患者90例，根據臨床表現分為典型組和不典型組，研究不典型嗜鉻細胞瘤患者年齡、腫瘤部位、腫瘤最大徑、高血壓、血漿兒茶酚胺等方面和典型組患者的差異。
結果　 90 例患者中有22 例（24.4%）為不典型腎上腺嗜鉻細胞瘤，68 例（75.6%）為典型腎上腺嗜鉻細胞瘤。兩組患者年齡、腫瘤平均最大徑均無顯著差異；不典型組腎上腺腫瘤主要位于右側腎上腺，其去甲腎上腺素濃度顯著低于典型組，且不典型組去甲腎上腺素陽性率也明顯低于典型組。
結論　本組資料顯示，和典型腎上腺嗜鉻細胞瘤相比，不典型腎上腺嗜鉻細胞瘤主要位于右側，且血漿去甲腎上腺素的檢出率低于前者，從腫瘤大小上無法鑒別出不典型腎上腺嗜鉻細胞瘤，但綜合患者的臨床表現、CT檢查、血漿兒茶酚胺檢測，大多數不典型嗜鉻細胞瘤都可在術前正確診斷。

引用本文： 易發現,魏強,沈宏,石明,范天勇,李響,李虹,楊宇如,董強. 22例不典型腎上腺嗜鉻細胞瘤的臨床分析. 中國循證醫學雜志, 2009, 09(1): 37-40. doi: 10.7507/1672-2531.20090011 復制

1.	Lucon AM, Pereira MAA, Mendonca BB, et al. Pheochromocytoma: Study of 50 cases. J Urol, 1997, 157 (4): 1208-1212.
2.	劉屹立, 徐彪, 孫強, 等. 不典型腎上腺嗜鉻細胞瘤. 中華泌尿外科雜志, 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.	楊紹波, 宮大鑫, 劉賢奎, 等. 腎上腺偶發嗜鉻細胞瘤. 中國醫科大學學報, 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.	姜元軍, 孫志熙, 宮大鑫, 等. 靜止型嗜鉻細胞瘤和非靜止型嗜鉻細胞瘤的比較. 臨床泌尿外科雜志, 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. 劉屹立, 徐彪, 孫強, 等. 不典型腎上腺嗜鉻細胞瘤. 中華泌尿外科雜志, 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. 楊紹波, 宮大鑫, 劉賢奎, 等. 腎上腺偶發嗜鉻細胞瘤. 中國醫科大學學報, 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. 姜元軍, 孫志熙, 宮大鑫, 等. 靜止型嗜鉻細胞瘤和非靜止型嗜鉻細胞瘤的比較. 臨床泌尿外科雜志, 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.

《中國循證醫學雜志》

22例不典型腎上腺嗜鉻細胞瘤的臨床分析

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《中國循證醫學雜志》

22例不典型腎上腺嗜鉻細胞瘤的臨床分析

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