Portal de Periódicos da CAPES

PHAeOCHROMOCYTOMA

1953; BMJ; Volume: 15; Issue: 2 Linguagem: Inglês

10.1136/hrt.15.2.241

1468-201X

M. Hamilton, J. W. Litchfield, W. S. Peart, G. S. C. Sowry,

Glioma Diagnosis and Treatment

The successful diagnosis and removal of pheochromocytomata have been reported with increasing frequency during the past few years, and it is probable that many cases have been missed in the past.At this hospital, six tumours have been removed since 1948, while none was recognized either at operation or post mortem during the preceding twenty years.This paper is based on five cases, three of them not previously described and two reported by Barnett et al. (1950).It is concerned especially with the clinical diagnosis and its confirmation by such methods as the biological assay of adrenaline and noradrenaline in the urine, the use of so- called adrenolytic drugs, and the estimation of skin blood flow.We also report assays of the urine and of-the tumours in two cases not under our care.CASE REPORTS Case 1. W.H., a man, aged 38, was well until 1946, when he developed increasing lassitude and anorexia and was found to have a B.P. of 180/110.Subsequently, he developed attacks of pallor, sweating, " goose-flesh," vomiting, and breathlessness.He was admitted to Chase Farm Hospital on 20/7/48 in a particularly severe attack, and was diagnosed as having a phaeochromocytoma by Dr. T. Simpson.There was profuse sweating and pallor, a B.P. of 200/140, bilateral papilledema with retinal exudates and hemorrhages, cardiac enlargement, pulsus alternans, gallop rhythm, and a mass palpable in the right loin.A phieochromocytoma was removed at St. Mary's Hospital on 23/9/48; he has remained symptom-free since with resolution of the retinal changes, but the blood pressure which was 160/120 until 10 months after the operation had risen to 230/130 four years afterwards.Case 2. B.H., a man, aged 31, had attacks of pallor and bradycardia as a boy of eleven which had led to the discovery ofa left bundle branch block with short P-R interval (Case 7 of Wolff, Parkinson, and White, 1930).These attacks subsided, but at the age of twenty-three he began to get attacks of epigastric dis- comfort, followed by slow, forceful palpitation, pallor, and sometimes throbbing headache, nausea, vomiting, and dyspnoea.His blood pressure between attacks varied from 120/86 to 170/110 and always rose during attacks, the highest recorded being 254/154.They were also marked by sweating, shivering, and slight bradycardia.A phieochromocytoma was removed on 12/11/49.He has been symptom-free since, his blood pressure on 6/6/52 being 135/80.Case 3. M.J., a women, aged 66, who had attacks of palpitation for 2 years, was admitted to hospital after three attacks of severe dyspncea with copious expectoration, sweating, and vomiting.The skin was found to be pale, cold, and sweating; the blood pressure varied from 150/90 to 270/180; marked enlarge- ment of the left ventricle was present, with a presystolic gallop rhythm, and there were retinal heemorrhages and soft white exudates, but no papilledema.Rises in the very labile blood pressure were associated with increased pallor, sweating, vomiting and usually tachycardia, but no sharply defined paroxysms were observed.Removal of a phaeochromocytoma from above the right kidney on 30/10/51 was followed by a dis- appearance of all symptoms.Eleven months later the blood pressure was 165/100.Case 4. E.G., a women, aged 40, with neurofibromatosis, was admitted to hospital having had attacks _R