內科網路繼續教育試題解析-BN9500302 | 嗜鉻細胞瘤之診斷可測病人中下何種物質
大部分的嗜鉻細胞瘤是偶發的(sporadic)，但是超過10％可以是遺傳的，這些病人需要 ... 性神經傳導物質，會累積在分泌catecholamine的細胞中，因此可以定位嗜鉻細胞瘤。
☆網路內科繼續教育☆有效期間：民國95年03月16日至95年03月31日止 CaseDiscussion Intermittentpalpitationandheadachefortwomonths. This54year-oldman,abossofafactory,isapatientwithdiabetesmellitusdiagnosedfor1year.Hetookoralhypoglycemicagents(glimeperide4mgQ.D,metformin500mgT.I.D)andhisaveragefastingplasmaglucoselevelwasaround110mg/dL.Twomonthspriortoadmission,hedevelopedintermittentpalpitationandheadache.Eachepisodeofwhichlastedseveralminutesandresolvedspontaneouslywithoutovertprecipitatingoraggravatingfactors.Occasionallytheepisodehappenedatbedtimeandwasaccompaniedbypallor,dizzinessandperspiration.Therewasnochesttightness,vomitingorabdominalpain.Hehadevervisitedalocalmedicalclinicwherehypertensionwasnoted.Becausetheseepisodeswereparoxysmal,herefusedtotakeanymedication.Hedeniedafamilyhistoryofhypertension. Becausethefrequencyofheadacheincreasedrecently,heunderwentahealthexamination.Wholebodymagneticresonanceimagingrevealedaleftadrenaltumormeasuring3.2cmindiameterwhichpresentedwithhyperintensesignalonT2-weightedimage(fig1&2).Wholebodypositronemissiontomography(PET)showednegativefindings.Secondaryhypertensionwhichwasrelatedtoapheochromocytomawashighlysuspectedandhewasadmittedforfurtherstudy. Physicalexaminationrevealeda76kg,169cmtallmanwithoutroundface,acneortruncalobesity.Hisbloodpressurewas120/80mmHg,respiratoryratewas18/min,pulseratewas88/minandhistemperaturewas36.2℃.Hisconsciousnesswasclear,conjunctivaewerepink,andhisscleraewereanicteric.Thepupilswereisocoricwithpromptlightreflex.Theneckwassupplewithoutgoiter,lymphadenopathy,engorgedjugularveinsorcarotidbruit.Chest,abdominalandextremityexaminationswerenormal.Therewasnogynecomastia,galactorrhea,buffalohumporpurplestriae.Table1.EndocrinetestReninAldosteroneCortisol(8AM)Cortisol(4PM)DHEA-SO4* ng/mL/hr ng/dLμg/dLμg/dLμmol/L3.48(1-5)19.5(5-30)10(5-25)6(2.5-12.5) 4
☆網路內科繼續教育☆有效期間：民國95年03月16日至95年03月31日止 CaseDiscussion