심실빈맥의 발작으로 발현된 갈색세포종 1예
A Case of Pheochromocytoma Presenting as Ventricular Tachycardia Storm
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초록
두통과 두근거림을 주소로 입원한 32세 여자 환자의 심전도 검사에서 단형 지속성 심실 빈맥이 확인되었다. 심실빈맥이 나타나기 전에 갈색세포종의 특징적인 증상 및 징후의 하나인 두통과 발한이 먼저 나타났으나 고혈압은 없었다. 심실빈맥의 발생을 억제하기 위해 베타 차단제를 투여하였으나오히려 심실빈맥의 발생빈도가 증가하고 지속시간이 길어졌다. 24시간 보행 심전도 검사에서 다양한 형태의 QRS파를 가지는 심실조기박동, 가속 심실고유리듬, 심실빈맥이 순차적으로 출현하면서 맥박수가 빠르게 증가하는 것이 확인되어증가한 자동능에 의해 심실빈맥이 유발되는 갈색세포종의 가능성을 고려할 수 있었다. 영상 및 내분비 검사를 통해 부신에서 발생한 갈색세포종을 진단하였으며 알파 차단제 투여를시작한 후 심실빈맥의 발생이 억제되어 안전하게 갈색세포종적출술을 시행할 수 있었다.
Abstract
A 35-year-old woman was admitted for recurrent palpitations and headache with cold sweats. No structural abnormality was detected via cardiac imaging studies. A standard 12-lead electrocardiogram (ECG) revealed sustained monomorphic ventricular tachycardia (VT). Propranolol (120 mg/day) was administered; however, the frequency and duration of VT episodes increased rapidly. A 24-hr ambulatory ECG revealed frequent, successive, premature ventricular beats; accelerated idioventricular rhythms; and VTs with various cycle lengths and QRS complex morphologies. ECG findings suggested that the observed ventricular arrhythmias were driven by accelerated automaticity as their main electrophysiological mechanism. Based on clinical manifestations and ECG findings, pheochromocytoma was suspected. Solitary left adrenal pheochromocytoma was diagnosed by endocrine and imaging studies. Instead of propranolol, oral doxazosin (8 mg/day) was administered, and symptoms and VT attacks were successfully suppressed. After surgical resection of the pheochromocytoma, clinical VT was not observed in response to the high-dose isoproterenol provocation test.
참고문헌 (9)
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