We report the case of an 84-year-old woman who was initially admitted to the emergency room of our institution for frank dehydration caused by acute and severe secretory diarrheas along with acidosis and hypokalemia. After extensive gastrointestinal investigations, the etiology of the diarrhea remained unclear. Because clinical symptoms and ionogram parameters worsened, despite intravenous fluids and electrolyte replacement, an abdominal CT scan was performed and unexpectedly revealed a 4.5-cm mass in the right adrenal gland. Several separate 24-hour urine catecholamines were shown to be highly elevated. The diagnosis of pheochromocytoma was confirmed by MIBG scintigraphy and MRI. Before the admission, the patient never experienced symptoms suggestive of pheochromocytoma, except dry mouth and fear of impending death on several occasions. After 2 weeks, the diarrhea stopped abruptly and spontaneously without specific medication but after adequate rehydration. The patient subsequently underwent surgical removal of the adrenal medullary mass. Postoperatively, urinary catecholamines returned to normal values. Immunohistochemical study of the tumor confirmed the diagnosis of pheochromocytoma and revealed the presence of VIP-positive cells organized as islets in scattered areas of the tissue. This case illustrates the protean mode of presentation of pheochromocytoma, as well as the ability of medullary neural crest-derived cells to produce various neuropeptides potentially responsible for a large variety of symptoms.

译文

:我们报告了一名84岁妇女的案例,该妇女最初因急性和严重的分泌性腹泻以及酸中毒和低血钾症而导致的坦率脱水,被送入我们机构的急诊室。经过广泛的胃肠道检查,腹泻的病因仍不清楚。由于临床症状和电离图参数恶化,尽管静脉输液和补充电解质,但仍进行了腹部CT扫描,出乎意料的显示出右肾上腺的肿块为4.5厘米。几个单独的24小时尿儿茶酚胺显示高度升高。嗜铬细胞瘤的诊断已通过MIBG闪烁显像和MRI证实。入院前,患者从未经历过暗示嗜铬细胞瘤的症状,除了口干和害怕几次死亡。 2周后,腹泻突然停止,无需特殊药物治疗,但需适当补液。患者随后接受了手术切除肾上腺髓质肿块。术后尿儿茶酚胺恢复正常。肿瘤的免疫组织化学研究证实了嗜铬细胞瘤的诊断,并揭示了在组织的散布区域中以胰岛组织的VIP阳性细胞的存在。这种情况说明了嗜铬细胞瘤的蛋白质表现形式,以及髓神经c来源的细胞产生可能引起多种症状的各种神经肽的能力。

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