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Isquemia crítica de membro em doente com HTA resistente à terapêutica : caso clínico
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O feocromocitoma é um tumor raro com origem nas células cromafins da medula da glândula supra-renal. A sua principal manifestação clínica é a hipertensão e deve estar presente sempre no diagnóstico diferencial da hipertensão resistente à terapêutica, com ou sem outro tipo de sintomas, já que é um tumor com uma alta taxa de morbilidade e mortalidade quando não tratado. A sua excisão cirúrgica atempada é curativa. Após uma breve revisão sobre a fisiopatologia, manifestações clínicas, diagnóstico, tratamento e associações entre o Feocromocitoma e a Diabetes Mellitus (DM) e a Doença Arterial Periférica (DAP) apresentamos e discutimos um caso clinico excecional pela sua raridade. Este contempla uma doente de 51 anos, com antecedentes de HTA, DAP e DM tipo 2 com lesão de órgão-alvo, internada por úlcera necrosada do pé esquerdo e EAMSST. Durante o mesmo, por hipertensão resistente à terapêutica, é iniciado estudo de causas secundárias de Hipertensão, tendo sido diagnosticada com Feocromocitoma. A doente acabou por desenvolver isquemia crítica da perna esquerda com posterior amputação da mesma. Discutimos criticamente o caso, abordando falhas cometidas no diagnóstico do mesmo, e o sinergismo entre o feocromocitoma e as outras co-morbilidades presentadas pela doente.
Pheochromocytoma is a rare tumor which arises from chromaffin cells of the adrenal medulla. Its major clínical manifestation is hypertension, and, as such, pheochromocytoma must always be included in the differential diagnosis of resistant hypertension, with or without other symptoms, given the high morbidity and mortality rate of this tumor when left untreated. The surgical resection of the tumor is curative. After a brief review about the pathophysiology, clinic presentation, diagnosis, treatment and the association of pheochromocytoma with Hypertension, Diabetes mellitus (DM) and Peripheral Artery Disease (PAD), we present and discuss a case report, exceptional for his rarity. It involves a 51 year-old woman, with PAD and DM type 2 with target organ damage admitted for a NSTEMI and a necrotizing left feet ulcer. During such hospital stay, given the presence of resistant hypertension, the patient is evaluated for causes of secondary hypertension and is diagnosed with pheochromocytoma. The patient developed critical limb ischemia on the left leg that had to be amputated. We follow the case report with a discussion of said case, the flaws committed during the evaluation of the patient, and the synergism between the pheochromocytoma and other co-morbidities presented by the patient.
Pheochromocytoma is a rare tumor which arises from chromaffin cells of the adrenal medulla. Its major clínical manifestation is hypertension, and, as such, pheochromocytoma must always be included in the differential diagnosis of resistant hypertension, with or without other symptoms, given the high morbidity and mortality rate of this tumor when left untreated. The surgical resection of the tumor is curative. After a brief review about the pathophysiology, clinic presentation, diagnosis, treatment and the association of pheochromocytoma with Hypertension, Diabetes mellitus (DM) and Peripheral Artery Disease (PAD), we present and discuss a case report, exceptional for his rarity. It involves a 51 year-old woman, with PAD and DM type 2 with target organ damage admitted for a NSTEMI and a necrotizing left feet ulcer. During such hospital stay, given the presence of resistant hypertension, the patient is evaluated for causes of secondary hypertension and is diagnosed with pheochromocytoma. The patient developed critical limb ischemia on the left leg that had to be amputated. We follow the case report with a discussion of said case, the flaws committed during the evaluation of the patient, and the synergism between the pheochromocytoma and other co-morbidities presented by the patient.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Hipertensão resistente Feocromocitoma Isquemia crítica de membro Doença arterial periférica Diabetes mellitus