지메스컨설팅

자료실(수강자료)

Pheochromocytoma의 진단 및 치료(2CK)
운영자 / 2005-09-16 11:29:23

Rollie Hendrix is a 35-year-old husband and father of three children. Over the past six months he has experienced headaches and palpitations of increasing frequency and severity. In addition, he has had periods of intense anxiety and panic attacks. His wife Arlene has noticed that Rollie’s face is often pale and that he sweats more. Upon examination by his physician, Rollie was found to be severely hypertensive and in atrial fibrillation.Which is the most likely diagnosis?

Pheochromocytom
Important feature
1. Headache
2. Diaphoresis or Sweating
3. Palpitations
4. Anxiety

Lab
1.24-hour Urine Metanephrine and Urine VMA
2.Plasma Free Metanephrines
3.Plasma Catecholamines (equivocal metanephrines)
4.Clonidine Suppression (positive Catecholamines)

Radiology
Adrenal CT or Adrenal MRI
MIGB Scan (metaiodobenzyl-guanidine)

treatment
1.Preoperative Medical Management
Alpha Adrenergic Receptor antagonist (2 weeks pre-op)
Phenoxybenzamine PO bid
Phentolamine IV prn
Beta Blocker (only start after alpha blockade)

2.Surgical Management
Laparoscopic adrenalectomy(if Single, small adrenal tumors)
Open Adrenalectomy (if Adrenal tumor size over 7 cm)

3.Monitoring
Screen Urine Metanephrines annually
Screen Urine Catecholamines annually