褐色細胞腫の摘出後に著明な低血糖を呈した1例

Abstract

39歳男性.患者は動悸で受診し, 内服薬を自己判断で休薬し, 症状の増悪で入院となった.血液検査では血中カテコールアミン(CA)はエピネフリン(E)およびノルエピネフリン(NE)の異常高値とドーパミン(DA)の高値を認め, 尿中CAはE, NE, DA, バニリルマンデル酸(VMA)が異常高値であった.CTでは右腎上方に7.5×5×7cmの軟部腫瘍を認め, 中心部は不均一な低吸収域を呈していた.MRIのT1ならびにT2強調では腎実質と等信号で内部に高信号域を認め, 131I-MIBGシンチグラフィでは右副腎の病変に一致して強い集積像を認めた.これらより右副腎腫瘍を疑い経腹的右副腎腫瘍摘出術を施行した.術後2時間後に意識レベルが混濁し, 多量の発汗を認め, 血糖値38mg/dlと異常低値が生じたものの, 高カロリー輸液と50%ブドウ糖の点滴静注により, 症状は消失し, 血中と尿中CA値も正常化した.なお, 病理所見褐では色細胞腫であった

We report a case of severe hypoglycemia following resection of pheochromocytoma. A 39-year-old male was admitted to our hospital with a chief complaint of palpitation. Blood pressure and fasting blood glucose were within the normal range. Computed tomography and magnetic resonance imaging revealed a right adrenal tumor (7.5 x 5 x 7 cm) and 131I-MIBG scintigraphy showed marked tumor uptake of isotope. As plasma and urinary catecholamine levels were very high, a clinical diagnosis of pheochromocytoma was established. Doxazosin and propranolol were administered for 43 days prior to adrenalectomy. During intensive care monitoring 2 hours postoperatively, the patient became drowsy and began to sweat. Although blood pressure remained stable, severe hypoglycemia (38 mg/dl) and hyperinsulinism (63.67 microU/ml) were confirmed. Infusion of 50% glucose improved these symptoms and plasma glucose level and insulin secretion normalized within 15 days of surgery. We also reviewed 25 cases of hypoglycemia after resection of pheochromocytoma. We recommend close monitoring of blood glucose for at least 6 hours after adrenalectomy for pheochromocytoma.