LECTURA CRITICA A UNUI STUDIU UNUI STUDIU

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EXEMPLU Cardiac .. phaeochromocytoma presenting with severe hypertension and chest pain A. M. Sawka*, W. F. Young Jr*,t and H. V. Schaff* may be highly vascular, invasive and difficult to * Division of Endocrinology, Metabolism and Nutrition, resect, it can be cured. Internal Medicine, tDivision of Hypertension and Internal Medicine Medicine, :j:Division of Cardiovascular Surgery Surgery, Mayo ... ClInic, Mayo FoundatIon, Rochester, MN, USA Phaeochromocytomas are catecholamine-producing neoplasms (Received 14 March 2000; returned for revision 14 Apri12000; .. '" -'.
REZUMAT .. Summary Cardiac phaeochromocytoma is a rare cause of endocrine hypertension hypertension. We report a case of a 25year-old woman, who presented with severe hypertension and intermittent chest pain. The patient denied typical phaeochromocytoma spells of palpitation, headache, and diaphoresis. The 24-hr urinary excretion of norepinephrine p p was increased sevenfold above the upper limit of normal; however, the excretion of total metanephrines, epinephrine, and dopamine were normal. Computed tomography (CT) scan of the abdomen was normal. An 1311-labelled metaiodobenzylguanidine (MIBG) scan was falsely negative while the patient was taking labetalol. The cardiac phaeochromocytoma was localized with indium-111-pentetreotide scintigraphy and chest magnetic resonance imaging scan. Repeat 1231-MIBG scintigraphy was positive after discontinuing labeta- 101 101. The cardiac phaeochromocytoma was located in the right atrial groove, adjacent to the tricuspid valve, and contained multiple ~eeder arteries from the right coronary artery. After treatment with volume expansion, (X-methyl-p-tyrosine, and (X- and fl-adrenergic blockade, , surgical g resection was performed. p While under cardiopulmonary bypass, coronary bypass grafting and tricuspid annuloplasty were performed to facilitate the complete surgical resection of the 4.5cm tumour. The surgical course was uncomplicated, with complete cure of hypertension and normaliization ti of f catecholamine t h l i excretion. ti PPost-operative t ti cardiac function, as measured by echocardiogram, was normal. Although cardiac phaeochromocytoma
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LECTURA CRITICA A UNUI STUDIU UNUI STUDIU

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