嗜铬细胞瘤复发转移致儿茶酚胺相关心肌病1例

Recurrent Metastasis of Pheochromocytoma Causing Catecholamine-Associated Cardiomyopathy: A Case Report

摘要: 嗜铬细胞瘤是一种罕见的神经内分泌肿瘤，可释放大量儿茶酚胺造成多系统损害，本文报道1例嗜铬细胞瘤术后5年复发并多发转移致儿茶酚胺相关心肌病的患者。患者中年女性，急性起病，完善心电图及心肌损伤标志物后初步诊断为急性ST段抬高型心肌梗死合并急性心力衰竭，行急诊冠脉造影未见明显异常。完善血尿儿茶酚胺代谢产物浓度显著升高，影像学提示双肺、双侧胸膜及纵隔、肝脏多处转移，考虑儿茶酚胺相关心肌病，予以抗心衰药物治疗后心功能好转出院。患者出院后多次复查心脏结构及功能未见明显异常。患者肿瘤广泛转移，多次行¹³¹I-MIBG治疗及复查，预后不佳，6个月后临床死亡。

Abstract: Pheochromocytoma is a rare neuroendocrine tumor that releases large amounts of catecholamines causing multisystem damage. In this paper, we report a case of pheochromocytoma recurrence and multiple metastases resulting in catecholamine-associated cardiomyopathy 5 years after surgery. The patient was a middle-aged woman with an acute onset of illness and was initially diagnosed as acute ST-segment elevation myocardial infarction combined with acute heart failure after completing the electrocardiogram and markers of myocardial injury, and no obvious abnormality was found in the emergency coronary angiography. The blood and urine catecholamine metabolite concentrations were significantly elevated, and the imaging suggested multiple metastases in both lungs, bilateral pleura and mediastinum, and liver, so the patient was considered to have catecholamine-associated cardiomyopathy, and was discharged from the hospital with improved cardiac function after symptomatic treatment. The patient was discharged from the hospital with no significant abnormality in the cardiac structure and function on multiple reviews. The patient had extensive tumor metastasis and underwent multiple ¹³¹I-MIBG treatments and follow-up examinations. The prognosis was poor and the patient died 6 months later.