1980 Volume 71 Issue 7 Pages 788-796
Two cases of pheochromocytoma, one in a 7 year-old child and the other in a 70 year-old woman were reported. The former was the youngest and the latter the oldest surgical case in Japan.
Case 1: A 7 year-old boy was admitted to our hospital due to easy fatigability, hypertension and excessive sweating lasting for one year. Physical examination revealed a clever well-nourished boy with normal body developments. He showed proteinuria and elevated basal metabolic rate. The urinary excretions of catecholamines were elevated and phentolamine test was positive. Tomograms after pneumoretroperitoneum revealed a mass in the upper abdomen. With the suspicion of an ectopic pheochromocytoma exploratory laparotomy was performed. Surgery revealed a fist-sized tumor located behind the vena cava and bilateral renal vein, lateral to the aorta and anterior to the vertebral column. The tumor was removed completely. Both adrenals were normal and were not resected. Pathological diagnosis was a pheochromocytoma arising from the organ of Zuckerkandl. Convalescence from the surgery was uneventful and all the symptoms disappeared. The postoperative level of urinary noradrenalin was still high, although less in amount. The excretions of catecholamines returned normal 2 years after surgery. He was well without any signs of recurrence for 5 years.
Case 2: A 70 year-old woman with a history of hypertension for 2 years was referred to our hospital because her hypertension was difficult to control. Physical examination disclosed an elevated blood pressure of 2 76/140, pulse deficits and sclerotic arterial walls. Routine laboratory studies revealed a high fasting blood glucose level, proteinuria and glucosuria. Glucose tolerance test showed a diabetic pattern. The urinary excretions of catecholamines were elevated. Phentolamine and abdominal massage tests were positive. Abdominal aortography revealed a mass measuring 5×4cm in the right adrenal region. Surgery was performed under the diagnosis of right adrenal pheochromocytoma. An adrenal tumor, weighing 35gm and 4.2×4.0×2.8cm in size was removed. Histology was a typical pheochromocytoma of the right adrenal gland. She recovered from the surgery without anycomplications. Although all the laboratory data returned normal, mild hypertension lasted after surgery. Hypertension, however, was easily controlled by anti-hypertensive agents.
In the Japanese literature, we have found 31 children and 34 elderly people suffering from the pheochromocytoma. The analysis of these cases showed that pheochromocytomas were more frequent in the males than in the females in the children and the reverse was true in the elderly people.
Malignant pheochromocytoma occurred in 14 (40%) of the 35 elderly cases and only in 2 (6.3%) of the 32 children. Signs and symptoms were more manifest in the children than in the aged. The clinical signs were scanty in the aged and it was not unusual that the hypertension was the sole symptom. Results of surgery were satisfactory in children (28 of 30, 93.3%) compared with those of the aged (11 of 15, 73.3%), The infrequent signs and symptoms in the elderly cases may cause the delay of diagnosis which, in turn, may explain the lower rate of surgical cure. The early diagnosis and prompt treatment is desirable for the elderly people with this disease.
