내분비-대사분과 - 대한내과학회
내분비-대사분과 - 대한내과학회
내분비-대사분과 - 대한내과학회
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<strong>내분비</strong><strong>대사분과</strong> 567<br />
4. 감별 진단<br />
표 1. Pheochromocytoma의 감별진단<br />
Anxiety, panic attacks, psychoneurosis, tension states, Hyperthyroidism<br />
Paroxysmal tachycardia, Hyperdynamic adrenergic circulatory state<br />
Menopause, Vasodilating headache (migraine and cluster headache)<br />
Coronary insufficiency syndrome, Acute hypertensive encephalopathy<br />
Diabetes mellitus, Renal parenchymal or renal arterial disesase with hypertension<br />
Focal arterial insufficiency of the brain: cerebral vasculitis<br />
Intracranial lesion (with or without increase in intracranial pressure)<br />
Autonomic hyperreflexia, Toxemia of pregnancy<br />
Diencephalic seizure : Pages syndrome; dopamine surges<br />
Hypertensive crises associated with monoamine oxidase inhibitor<br />
Carcinoid, Hypoglycemia<br />
Mastocytosis, Familial dysautonomia<br />
Acrodynia, Unexplained shock<br />
Neuroblastoma; ganglioneuroblastoma : ganglioneuroma<br />
Acute infectious disease : acute abdomen(cardiovascular catastrophe)<br />
Neurofibromatosis<br />
Rare causes of paroxysmal hypertension (adrenal medullary hyperplasia; acute porphyia; lead<br />
poisoning) ; tabetic crisis ; etc<br />
Circumstances simulating pheochromocytoma<br />
내<br />
분<br />
비<br />
대<br />
사<br />
5. 치료<br />
치료 : 수술적 절제, 수술중 사망률 2-4%<br />
1) 급성기 치료<br />
가) 침대머리를 높이고 안정<br />
나) pentolamine 2.5 mg IV q5 min<br />
다) Na-nitroprusside 100 mg in D/W 500 mL<br />
라) 부정맥시 propranolol 1-2 mg IV, 5-10분마다<br />
표 2. 크롬친화성 세포종의 내과적 치료<br />
Therapeutic target<br />
Control of blood pressure<br />
Medical therapy<br />
Alpha-blockers<br />
(phenoxybenzamine, terazocin)<br />
Calcium channel blockers<br />
Metyrosine
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