褐色細胞腫の臨床的観察

Abstract

1976年以降10年間に経験した本症11例についての検討では, 1) 50歳代に最も多く, 男女比は5:6.2)臨床症状では持続型と発作型高血圧が相半ばしており, 頭痛, 動悸, 悪心嘔吐が主であったが, 無症候例も1例みられた.3)腫瘍存在部位は, 右副腎4例, 左副腎3例, 両側副腎2例, 副腎外性3例(うち1例は多発性で右副腎と合併).4)検査成績では, 耐糖能異常が72.7%と高率で, 眼底異常, 心電図異常を認める症例が多かった.カテコールアミンは全例で高値を示したが, 発作型ではA(アドレナリン)優位, 副腎外性ではNA(ノルアドレナリン)優位の傾向がみられた.5)腫瘍の局在診断ではCTが有効であり, 超音波断層法, 副腎シンチ, 静脈血サンプリングも補助診断として有用.6)術前処置として, α-, β-blocker投与と輸血を施行した.術中shockは1例のみにみられた.発作型2例と無症候例では術前処置を施行しなかったが, 術中術後に問題はなかった.7)高血圧治癒率は81.8%であった高血圧持続例については厳重にfollow upしているが, 病変の再発は認めていない

Eleven cases of pheochromocytoma observed at our department between 1976 and 1985 are presented. There were 5 males and 6 females and they were between 18 and 59 years old. The site of the tumor was in the right adrenal in 4 cases, left adrenal in 3 cases, bilateral adrenals in 2 cases and extra adrenal in 3 cases, 1 of which had multiple lesions and involvement of the right adrenal. Clinical symptoms observed were hypertension in 10 cases, headache in 7 cases, palpitation in 3 cases and nausea in 2 cases. Atypical adrenal pheochromocytoma was seen in 1 case. Definitive diagnosis was established by determination of urinary catecholamine levels in the 24-hour sample. Urinary levels of catecholamine revealed higher adrenaline levels for paroxysmal type and higher nor-adrenaline levels for extra-adrenal cases. For localization of tumors, computed tomography was most useful with a diagnostic rate of 100%, followed by ultrasonography and adrenal scan. As preoperative treatment, blood transfusion and administration of adrenergic blocking agents were performed in 9 cases. In all but 2 cases, hypertension was improved and no recurrence was seen after the operation.