万颂　习明　万跃平　华伟　杨桂莲

【摘要】 目的：探讨肾上腺嗜铬细胞瘤并血皮质醇升高的临床特点和诊治方法。方法：回顾分析3例肾上腺嗜铬细胞瘤并并血皮质醇升高病例资料。结果：3例均有高血压、高血糖。尿VAM轻微升高，而血浆肾素、血管紧张素活性均正常。经B超、CT均诊断为肾上腺肿瘤，行患侧肾上腺切除术，术后血糖恢复正常，高血压消失或明显缓解。病理诊断为嗜铬细胞瘤。结论：肾上腺嗜铬细胞瘤并发皮质醇症均有不同程度的皮质醇症表现，部分病例同时有儿茶酚胺症的特点，综合分析临床资料可能在术前作出诊断，围手术期应按儿茶酚胺症处理，确诊需病理检查。

【关键词】 肾上腺疾病； 血皮质醇； 嗜铬细胞瘤

中图分类号 R586 文献标识码 B 文章编号 1674-6805（2016）5-0163-02

【Abstract】 Objective：To study the clinical features，diagnostic and treatment of pheochromocytoma with high serum cortisol as manifestation.Method：The clinical data of three cases were retrospectively analyzed.Result：All the 3 cases had hypertension and hyperglycemia.The serum cortisol were high.But the plasma renin and angiotensin Ⅱ activity were normal and urinary catecholamine and its metabolites were lightly increased.The adrenal tumor were revealed on ultrasonography，CT scan.The size of the tumors was 1.0 to 5.5 cm in diameter.Resection of the involved adrenal gland was performed in all the patients.After operation，the glucose level became normal with hypertension disappeared or significantly relieved.Pathology studies revealed pheochromocytoma.Conclusion：High serum cortisol can be seen in all three cases and features of pheochromocytoma can be found in some of the cases.Preoperative diagnosis may be assessed if the clinical data is comprehensively analyzed.Perioperative management should be the same as in pheochromocytoma.The final diagnosis dependents on pathologic studies.

【Key words】 Adrenal gland diseases； Serum cortisol； Pheochromocytoma

First-authors address：Guangzhou Huadu Poeples Hospital Affiliated to Southern Medical UniVersity，Guangzhou 510800，China

doi：10.14033/j.cnki.cfmr.2016.5.089

關于血皮质醇高为表现的肾上腺嗜铬细胞瘤，国内外极为罕见。本文回顾分析3例肾上腺嗜铬细胞瘤并血皮质醇升高病例资料，发现肾上腺嗜铬细胞瘤并发皮质醇症均有不同程度的皮质醇症表现，部分病例同时有儿茶酚胺症的特点。

1 病例介绍

回顾性分析1996年7月-2014年12月在笔者所在科住院治疗的血皮质醇高为表现的肾上腺嗜铬细胞瘤患者，均采用手术切除治疗，具体情况如下。

患者1，女，48岁，因多食、多饮、多尿、体重下降及渐进性高血压1年半，腰痛3个月于1998年5月17日入院。既往健康。查体：血压160～200/90～110 mm Hg，满月脸、轻度向心性肥胖，皮肤无紫纹及压疮。B超提示：左肾上腺区可见一3 cm×

5 cm肿物，界清。空腹血糖8.9 mmol/L；血钾3.0 mmol/L。皮质醇（8∶00）796 ng/ml；皮质醇（16∶00）550 ng/ml；……