褐色細胞腫の1例

Abstract

Many reports were published about pheochromocytoma in these days, but there are still many problems to be solved as to the relation between the hypertensive symptom and the catecholamine value in patients with this cytoma. Recently the authors experienced a case of what is called asymptomatic pheochromocytoma in which the patient showed a significant increase in urinary and blood level of catecholamine, but blood pressure was normal at the time of admission. This 51 year-old woman visited this hospital with a complaint of a mass in the abdomen. Past history showed that she had been hospitalized for 2 months because of angina pectoris suspected 10 years ago and she was also pointed out to have enlarged gallbladder 7 years ago. Six months prior to admission she fell down with an attack of hypertention of 230 mmHg systolic, but her blood pressure was restored to normal in a'week. At that time her urine was positive for VMA and she had a slight headache several times a day. At the time of the present admission the patient had a mass palpated in the right hypochondria I region but no other symptom; blood pressure was 120/80; hematological and blood biochemical study showed no abnormality; but X-ray films showed a huge mass in the right posterior part of the peritoneal cavity, and the presence of a noradrenalin dominant pheochromocytoma was suggested. The mass removed was a simple cystoma of pheochromocytoma weighing 2, 832 g. The authors have considered through this case as follows: 1) Patients with pheochromocytoma have individual threshold values of susceptibility to catecholamine, and the interrelation between the individual variation of the threshold value and the amount of catecholamine secretion determines whether a patient has hypertention or only associated symptoms. 2) The so-called asymptomatic pheochromocytoma should rather be called pheochromocytoma ofthe normal blood pressure type, because it also causes various associated symptoms other than hypertention. Patients with pheochromocytoma may be of either the normal blood pressure type or of the hypertensive-type according to the amount of catecholamine secretion.