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首页> 外文期刊>Medical science monitor : >Severe postoperative hypoglycemia in a patient with pheochromocytoma and preclinical Cushing's syndrome.
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Severe postoperative hypoglycemia in a patient with pheochromocytoma and preclinical Cushing's syndrome.

机译：嗜铬细胞瘤和临床前库欣综合征的患者术后严重低血糖。

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BACKGROUND: Postoperative hypoglycemia is not a common complication following the removal of a pheochromocytoma. Although the mechanism of hypoglycemia is not fully understood, it seems that it is caused by excessive rebound secretion of insulin after surgical resection of pheochromocytoma. CASE REPORT: We report a 43-year-old woman with a very rare association of pheochromocytoma and preclinical Cushing's syndrome (PCS) in the same adrenal gland who developed severe postoperative hypoglycemia. Pheochromocytoma was diagnosed by high serum and urine metanephrine and normetanephrine levels. PCS was characterized by blunted cortisol diurnal rhythm, low ACTH level, and failure of cortisol suppression by dexamethasone without any clinical signs of cortisol excess. In the early postoperative period after surgical removal of right adrenal gland, the patient lapsed into a stuporous state. The blood glucose level was 0.7 mmol/l. During the next 48 hours, normoglycemia was maintained with a continuous infusion of 20% glucose. On the third postoperative day, infusion was discontinued, oral feeds were introduced, and the plasma glucose level normalized. The patient did not have further episodes of hypoglycemia. Pathology revealed medullary pheochromocytoma and a cortical tumor of right adrenal gland. During the fifth postoperative day, plasma metanephrine and normetanephrine were 0.13 nmol/l and 0.30 nmol/l, respectively. Urinary metanephrine decreased to 0.5 pmol/24 h and normetanephrine to 2.8 micromol/24 h. CONCLUSIONS: This report indicates the importance of close monitoring of blood glucose level in a patient with pheochromocytoma after removal of an adrenal gland.
机译：背景：去除嗜铬细胞瘤后，术后低血糖并不常见。尽管低血糖的机制尚不完全清楚，但它似乎是由于手术切除嗜铬细胞瘤后胰岛素的过度反弹分泌引起的。病例报告：我们报道了一名43岁的女性，在同一肾上腺中，嗜铬细胞瘤与临床前库欣氏综合征（PCS）的关联非常罕见，而后者发生严重的术后低血糖症。血清和尿中的肾上腺素和去甲肾上腺素水平高可诊断为嗜铬细胞瘤。 PCS的特征是皮质醇的昼夜节律减弱，ACTH水平低，并且地塞米松抑制皮质醇失败，而没有任何皮质醇过量的临床迹象。在手术切除右肾上腺后的术后早期，患者陷入了僵直状态。血糖水平为0.7mmol / l。在接下来的48小时内，连续输注20％葡萄糖可维持血糖正常。术后第三天，停止输液，引入口服饲料，血浆葡萄糖水平恢复正常。该患者没有进一步的低血糖发作。病理显示髓质嗜铬细胞瘤和右肾上腺皮质肿瘤。在术后第五天，血浆间肾上腺素和去甲肾上腺素分别为0.13nmol / l和0.30nmol / l。尿中肾上腺素降低至0.5 pmol / 24 h，去甲肾上腺素降至2.8 micromol / 24 h。结论：该报告表明在除去肾上腺后密切监测嗜铬细胞瘤患者血糖水平的重要性。

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