A 49-year-old male with a history of hypertension presented at emergency department because of sudden onset of abdominal pain. Morphine was given to relieve pain. However, blood pressure rose to 180/110 mmHg after morphine and was difficult to control..

到底發生什麼事了?

沒錯..聰明睿智的你一定可以直覺地聯想到pheochromocytoma..這個又臭又長且不常見的medical term..

pheochromocytoma可能是單邊的(80%),雙側的(10%)甚至是不在腎上腺的(10%)..(見圖)

相關症狀並不一定會持續出現..有可能突發..發作的時候可能一陣心跳加速,開始流汗,頭痛,血壓升高..(這不是與看到...的時候一樣?)

這些病患使用opiates類藥物時會因為刺激釋放norepinephrine使血壓突然升高..

其它可能會引發高血壓的藥物包括methyldopa,carbidopa與TCAs..

診斷上依靠收集24-hr尿液檢驗VMA與metanephrine加上影像檢查

Adapted from N Engl J Med. 2007; 356: 601-10.