Pheochromocytoma
º¸Åë adrenal medulla¿¡¼ ¹ß»ýÇÏÁö¸¸ chromaffin cell ¶Ç´Â sympathetic ganglia
(extraadrenal pheochromacytoma or paragangliomas)¿¡¼ ¹ß»ýÇÒ¼öµµ ÀÖ´Ù.
HypertensionÀÌ °¡Àå ÈçÇÑ ÀÓ»ó¼Ò°ßÀ̸ç hypertensive paroxysm or crisis°¡ ȯÀÚÀÇ
¹Ý À̻󿡼 »ý±ä´Ù. pheochromocytoma´Â Àüü °íÇ÷¾ÐÀÇ 0.1%¸¦ Â÷ÁöÇÏÁö¸¸ ±³Á¤°¡´ÉÇÑ
Áß¿äÇÑ ¿øÀÎÀÌ´Ù.
1. º´¸®
1) À§Ä¡ ¹× ÇüÅÂ
80%°¡ unilateral & solitaryÀ̰í 10%´Â bilateral, 10%´Â extraadrenal¿¡ À§Ä¡ÇÑ´Ù.
¾ÆÀÌ¿¡¼´Â 1/4(25%)ÀÌ bilateralÀ̰í 1/4(25%)Àº extraadrenalÀÌ´Ù.
solitary lesionÀÏ °æ¿ì¿£ right side¿¡ ´õ Àß »ý±ä´Ù.
Å©±â´Â 3kgÀÌ»ó ÀÚ¶ó±âµµ ÇÏÁö¸¸ ´ëºÎºÐÀº 100g ¹Ì¸¸À̰í Á÷°æÀº 10cm ¹Ì¸¸ÀÌ´Ù.
Á¾¾çÀº highly vascularÇÏ´Ù.
10%¹Ì¸¸ÀÌ malignant
´Ù¸¥ endocrine tumoró·³ pheochromocytomaµµ Á¶Á÷ÇÐÀû ¸ð¾çÀ¸·Î ¾ç¼º°ú ¾Ç¼ºÀ»
±¸º°ÇÒ¼ö ¾ø°í local invasion or distant metastasis°¡ ÀÖÀ» ¶§ ¾Ç¼ºÀ» ÀǹÌÇÑ´Ù.
2) extraadrenal pheochromocytoma
20-40g, 5cm¹Ì¸¸ÀÌ´Ù.
´ëºÎºÐÀº º¹°³»¿¡ À§Ä¡ÇÑ´Ù: celiac, superior & inferior mesenteric ganglia
´ë·« 10%°¡ thorax¿¡ À§Ä¡Çϸç, UB¿¡´Â 1%, neck¿¡´Â 3%¹Ì¸¸ÀÌ »ý±ä´Ù.
ÀÌ·±°ÍµéÀº ÈçÈ÷ sympathetic ganglia³ª 9th, 10th cranial nerveÀÇ extracranial branch¿¡
»ý±ä´Ù.
3) catecholamine synthesis, storage, and release
pheochromocytoma´Â catecholamine¿Ü¿¡µµ ´Ù¾çÇÑ peptides¸¦ ºÐºñÇϴµ¥ ¿©±â¿¡´Â
endogenous opioids, adrenomedulin, endothelin, erythropoietin, PTH-related protein,
neuropeptide Y, and chromagranin A °°Àº °ÍµéÀÌ ÀÖ´Ù.
* epinephrine, norepinephrine, and dopamine
´ëºÎºÐÀÇ pheochromocytoma´Â norepinephrine, epinephrine µÑ´Ù ºÐºñÇÑ´Ù.
normal adrenal¿¡¼´Â norepinephrineÀÌ epinephrineº¸´Ù ´õ ¸¹´Ù.
´ëºÎºÐÀÇ extraadrenal pheochromocytoma¿¡¼´Â norepinephrine¸¸À» ºÐºñÇϸç
epinephrine¸¸À» ºÐºñÇÏ´Â °æ¿ì´Â °ÅÀÇ ¾ø´Ù.
MEN¿¡¼´Â epinephrine¸¸À» ºÐºñÇÏ´Â °æ¿ì°¡ ¸¹´Ù.
2. Familial pheochromocytoma
5%°¡ autosomal dominant·Î À¯ÀüµÇ´Âµ¥ pheochromocytoma´Üµ¶ ¶Ç´Â MEN type
2a(Sipple's syndrome) or type 2b(mucosal neuroma syndrome), von Hippel-Lindau's
retinal cerebellar hemangioblastomosis, or von Recklinghausen's neurofibromatosis¿Í
°°ÀÌ »ý±ä´Ù.
bilateral adrenal pheochromocytoma´Â familial syndrome¿¡¼ ÈçÇÏ´Ù.
MEN¿¡¼ÀÇ pheochromocytoma´Â ¹ÝÀÌ»óÀÌ bilateralÀÌ´Ù. µû¶ó¼ bilateral
pheochromocytoma°¡ ÀÖ´Â °æ¿ì´Â familial syndromeÀ» °í·ÁÇØ¾ß ÇÑ´Ù.
3. Genetic considerations
¨ç MEN 2A and 2B syndrome : chromosome 10¿¡ À§Ä¡ÇÑ RET protooncogeneÀÇ ÀÌ»ó°ú
°ü·Ã.
RET protooncogeneÀÇ Æ¯Á¤ºÎÀ§ mutationÀº pheochromocytoma¸¦ highly prediction
ÇÒ¼ö ÀÖ´Ù.
¨è von Hippel-Landau(VHL) syndrome : VHL tumor suppressor gene mutation
MEN 2 syndrome¿¡Ã³·³ VHL mutationµµ pheochromocytoma¿Í ¹ÐÁ¢ÇÑ °ü·ÃÀÌ ÀÖ´Ù.
Èï¹Ì·Î¿î »ç½ÇÀº RET protooncogene°ú VHL mutationµÑ´Ù sporadic
pheochromocytoma¿¡¼ somatic mutationó·³ ÈçÇÏ°Ô ¹ß»ýÇÏÁö´Â ¾Ê´Â´Ù´Â »ç½ÇÀÌ´Ù.
4. ÀÓ»ó Æ¯Â¡
young to midadult life¿¡ °¡Àå ÈçÈ÷ ¹ß»ýÇÏ°í ¿©ÀÚ¿¡¼ ¾à°£ ´õ ºóµµ°¡ ³ô´Ù.
´ëºÎºÐÀº hypertensive crisis, seizure disorder or anxiety attackÀ» ÀǽÉÇÒ Á¤µµÀÇ
paroxysmal symptoms, º¸ÅëÄ¡·á¿¡ Àß ¹ÝÀÀÇÏÁö ¾Ê´Â °íÇ÷¾ÐÀ¸·Î º´¿øÀ» ã°Ô µÈ´Ù.
1) hypertension
60%´Â sustained hypertensionÀ» °¡Áö¸ç ÀÌÁß ¹ÝÀº crisis or paroxysmÀ» °æÇèÇÑ´Ù.
³ª¸ÓÁö 40%´Â attack½Ã¿¡¸¸ Ç÷¾Ð»ó½ÂÀÌ ÀÖ´Ù.
2) paroxysms or crisis(1/2)
ÈçÇϰųª sporadicÇÏ°Ô ¹ß»ýÇÒ¼öµµ ÀÖ°í, ¼öÁÖ ³»Áö ¼ö°³¿ù°£°ÝÀ¸·Î ¹ß»ýÇÒ¼öµµ ÀÖ´Ù.
½Ã°£ÀÌ °¥¼ö·Ï ºóµµ, Áö¼Ó±â°£, ½ÉÇÑÁ¤µµ°¡ Áõ°¡ÇÑ´Ù.
attackÀÌ ÀÖÀ¸¸é ¼öºÐ¿¡¼ ¼ö½Ã°£ÀÌ»ó±îÁö Áö¼ÓÇϴµ¥ headache, profuse sweating,
palpitation, and apprehensionÀÌ »ý±ä´Ù.
paroxysmÀº º¹°³» ³»¿ë¹°ÀÇ À§Ä¡¸¦ À̵¿½ÃŰ´Â activity¿¡ ÀÇÇØ À¯¹ßµÈ´Ù.
attack½Ã anxiety°¡ µ¿¹ÝµÇÁö¸¸ mental or psychological stress°¡ crisis¸¦ À¯¹ßÇÏÁö´Â
¾Ê´Â´Ù.
3) other distinctive clinical features
* orthostatic hypotension
plasma volume°¨¼Ò ¹× blunted sympathetic reflexesÀÇ °á°ú·Î »ý±ä´Ù.
surgery or traumaµ¿¾È hypotension or shockÀÌ ¿¹»óÄ¡ ¾Ê°Ô ¹ß»ýÇÒ¼ö Àִµ¥ ¿©±â¿¡
À§ÀÇ µÎ°¡Áö ÀÎÀÚ°¡ À¯¹ß½ÃŲ´Ù. ÀϺÎȯÀÚ¿¡¼´Â hypotensive peptide adrenomedullinµµ
ÀúÇ÷¾Ð¿¡ ±â¿©ÇÑ´Ù.
¨ç cardiac manifestations
i) arrhythmia : sinus tachycardia, sinus bradycardia, supraventricular arrhythmia, PVC°¡
º¸°íµÇ¾ú´Ù.
ii) angina and acute MI : coronary artery disease°¡ ¾ø´õ¶óµµ »ý±æ¼ö ÀÖ´Ù.
catecholamineÀÌ myocardial oxygen comsumptionÀ» Áõ°¡½Ã۰í
coronary spasmÀÌ ischemic event¿¡ ±â¿©Çϱ⠶§¹®ÀÌ´Ù.
iii) cardiomyopathy
¨è carbohydrate intolerance(1/2)
¨é hematocrit: plasma volumeÀÇ °¨¼Ò·Î 2Â÷ÀûÀ¸·Î Hct»ó½Â
¨ê other manifestations
PTH-related proteinºÐºñ·Î ÀÎÇÑ hypercalcemia
IL-6ºÐºñ·Î ÀÎÇÑ fever, ESRÁõ°¡
catecholamine-mediated increases in metabolic rate & heat dissipationÀ¸·Î ÀÎÇÑ
temperature»ó½Â
polyuria, rhabdomyolysis
¨ë pheochromocytoma of the UB
micturitionµ¿¾È¿¡ typical paroxysm¹ß»ý
hematuria°¡ ¹Ý¼ö¿¡¼ º¸À̸ç cystoscopy·Î bladderº®¿¡ ºÙ¾îÀÖ´Â tumor¸¦ °üÂûÇÒ ¼ö
ÀÖ´Ù.
4) adverse drug reaction
i) opiates, histamine, ACTH, saralasin, and glucagon¿¡ ÀÇÇØ fatal paroxysmÀÌ À¯¹ßµÉ ¼ö
ÀÖ´Ù.: tumor¿¡ Á÷Á¢ ÀÛ¿ëÇÏ¿© catecholamineÀ» À¯¸®ÇÔ
ii) methyldopa: nerve endings³»¿¡ ÀúÀåµÈ catecholamineÀ» À¯¸®ÇÏ¿© Ç÷¾Ð»ó½Â
iii) TCA or guanethidine: neuronal uptake¸¦ block½ÃÄÑ circulating catecholaminesÀÇ
effect¸¦ Áõ°¡½ÃÅ´
5) associated disease
¨ç medullary carcinoma of the thyroid: MEN syndrome type 2a and 2b
¨è hyperparathyroidism : MEN 2a
¨é von Hippel-Lindau disease
pheochromocytoma¿Í neurofibromatosisÀÇ µ¿¹ÝÀº ÈçÄ¡ ¾ÊÁö¸¸ neurofibromatosisÀÇ
incomplete formÀÌ pheochromocytoma¿Í µ¿¹ÝµÉ¼ö ÀÖÀ¸¹Ç·Î hypertensionȯÀÚ¿¡¼
cafe au lait spot, vertebral abnormality, or kyphoscoliosis¿Í °°Àº minor manifestation
ÀÌ º¸À̸é pheochromocytoma¸¦ ÀǽÉÇÑ´Ù.
von Hippel-Lindau disease¿¡¼ pheochromocytomaÀÇ µ¿¹Ý·üÀº 10-25%³ª µÈ´Ù.
¨ê cholelithiasis(10-20%)
¨ë Cushing's syndrome: pheochromocytoma¿¡¼ ectopic ACTH secretionÀ¸·Î ÀÎÇÏ¿©
»ý±ä´Ù.
5. Áø´Ü
1) Biochemical test
: vanillylmandelic acid(VMA), metanephrine, free catecholamine
VMA´Â metanephrineÀ̳ª catecholamineº¸´Ù ƯÀ̵µ ¹× ¹Î°¨µµ°¡ ³·´Ù.
À§ÀÇ 3°¡Áö Áß 2°¡Áö¸¦ »ç¿ëÇÏ¿´À» ¶§ Áø´ÜÀÇ Á¤È®µµ¸¦ ³ôÀϼö ÀÖ´Ù.
24½Ã°£ urine sampleÀÌ ³ª°¥ ¶§ collectionÀÇ ÀûÀý¼ºÀ» Æò°¡Çϱâ À§ÇØ creatinineµµ °°ÀÌ
½ÃÇàÇϵµ·Ï ÇÑ´Ù. °¡±ÞÀû ȯÀÚ°¡ È޽ĽÃ, ¾à¹°À» º¹¿ëÇÏÁö ¾Ê´Â »óÅ¿¡¼, ÃÖ±Ù radiologic
contrast media¿¡ ³ëÃâµÇÁö ¾ÊÀº »óÅ¿¡¼ ÇÏ´Â °ÍÀÌ ÁÁ´Ù.
¨ç free catecholamine: normal totol urinary catecholamineÀº 100-150 ug/24hrÀÌ´Ù.
pheochromocytomaȯÀÚÀÇ ´ëºÎºÐÀº 250 ugÀ» ³Ñ´Â´Ù.
epinephrineÀ» ÃøÁ¤ÇÏ´Â °ÍÀÌ À¯¿ëÇѵ¥ ±× ÀÌÀ¯´Â adrenal lesionÀÇ °æ¿ì¿¡ epinephrine
secretionÀÌ Áõ°¡Çϸç(>50ug/24hr), MEN°ú µ¿¹ÝµÈ °æ¿ì´Â epinephrine¸¸ Áõ°¡Çϱ⠶§¹®
ÀÌ´Ù.
* false-positive
methyldopa, levodopa, labetalol, sympathomimetic amines
-> 2ÁÖ±îÁö catecholamine excretionÀ» Áõ°¡½ÃŲ´Ù.
sympathoadrenal systemÀÇ ÀÚ±ØÀ¸·Î endogenous catecholamineÀÌ Áõ°¡ÇÒ¼ö ÀÖ´Ù.
ÀÌ¿Í °°Àº »óȲÀ¸·Î´Â hypoglycemia, strenuous exertion, CNS disease with increased
intracranial pressure, severe hypoxia, and clonidine withdrawal
¨è metanephrine & VMA
´ëºÎºÐÀÇ lab¿¡¼ totoal metanephrineÀÇ normal upper limit´Â 1.3mgÀ̸ç, VMA´Â 7.0mg
ÀÌ´Ù.
pheochromocytoma ´ëºÎºÐÀÇ È¯ÀÚ´Â urinary metabolite°¡ »ó´çÈ÷ Áõ°¡ÇÏ¿© Á¤»óÀÇ 3¹è
ÀÌ»ó Áõ°¡ÇÑ´Ù. metanephrine excretionÀº exogenous and endoenous catecholamine
¹× MAO inhibitorÄ¡·á½Ã¿¡µµ Áõ°¡ÇÒ¼ö ÀÖ´Ù. VMA´Â endogenous and exoenous
catecholamine¿¡ ´ú ¿µÇâÀ» ¹ÞÁö¸¸ carbidopa¿Í °°Àº ¾à¹°¿¡ ÀÇÇØ Áõ°¡ÇÒ¼ö ÀÖ´Ù.
VMA excretionÀº MAO inhibitor¿¡ ÀÇÇØ¼ °¨¼ÒÇÑ´Ù.
¨é plasma catecholamine
plasma catecholamineÀº Á¦ÇÑÀûÀ¸·Î »ç¿ëµÈ´Ù. urinary catecholamine ÃøÁ¤ÀÌ ´õ
¸¸Á·½º·´´Ù.
ÀÓ»óÁõ»óÀº pheochromocytoma°¡ Àǽɵdzª uriary assay´Â borderlineÀÏ ¶§ plasma
catecholamineÃøÁ¤ÀÌ °¡Ä¡ÀÖ´Ù. Å©°Ô Áõ°¡ÇÑ total catecholamineÀº Áø´Ü¿¡ µµ¿òÀÌ µÈ´Ù.
sympathetic system activity¸¦ ¾ïÁ¦ÇÏ´Â ¾àÁ¦¿¡ ÀÇÇØ °Ë»çÀÇ À¯¿ë¼ºÀÌ Áõ°¡ÇÑ´Ù.
clonidine & ganglionic blocker´Â Á¤»óÀΰú essential hypertension¿¡¼ plasma
catecholamine levelÀ» °¨¼Ò½ÃŰ³ª pheochromocytomaȯÀÚ¿¡¼´Â catecholamine level
¿¡ °ÅÀÇ ¿µÇâÀ» ³¢Ä¡Áö ¾Ê´Â´Ù.
elevated or borderline catecholamine level ȤÀº clonidineÅõ¿©ÈÄ plasma or urinary
catecholamineÀÌ ¾ïÁ¦µÇÁö ¾Ê´Â °ÍÀº pheochromocytomaÁø´Ü¿¡ µµ¿òÀ» ÁØ´Ù.
¨ê pharmacologic test
i) phentolamine : Åõ¿© 2ºÐÈÄ Àû¾îµµ 35/25 mmHgÀÇ Ç÷¾ÐÀÌ °¨¼ÒÇÏ¿© 10-15ºÐ°£ Áö¼ÓÇÑ´Ù.
ÀÌ·¯ÇÑ ¾à¹°ÀÇ ¹ÝÀÀÀº Áø´ÜÀûÀÌÁö ¸øÇϸç biochemical confirmationÀÌ Áø´Ü¿¡ ÇʼöÀûÀÌ´Ù.
ii) provocation test in normotensive patient
: potentially dangerous and rarely indicated
±×·¯³ª glucagon provocative test´Â aroxysmal hypertension ¹× nondiagnostic basal
catecholamine levelÀ» °¡Áö´Â ȯÀÚ¿¡¼ »ç¿ëµÉ¼ö ÀÖ´Ù.
glucagonÀº Á¤»ó ȤÀº °íÇ÷¾Ð ȯÀÚ¿¡¼ BP or plasma catecholamine level¿¡ °ÅÀÇ ¿µÇâÀÌ
¾ø´Ù.
±×·¯³ª pherochromocytoma¿¡¼´Â BP or circulating catecholamine level¸ðµÎ¸¦
Áõ°¡½ÃŲ´Ù.
6. °¨º°Áø´Ü
¨ç pressor crisis d/t clonidine withdrawal & cocaine abuse or MAO inhibitor
Áø´ÜÀÌ ¾î·Á¿î °æ¿ì¿¡ clonidine suppression & glucagon stimulation test±î À¯¿ëÇϰÔ
»ç¿ëµÉ ¼ö ÀÖ´Ù. clonidine withdrawal & cocaine or MAO inhibitor»ç¿ë°ú °ü·ÃÇÏ¿© pressor
crisis°¡ ¿Ã ¼ö Àִµ¥ ÀÌ´Â pheochromocytomaÀÇ paroxysm°ú ºñ½ÁÇÏ´Ù.
¨è factitious crisis´Â Á¤½Å°úÀûÀ¸·Î ¹®Á¦°¡ Àִ ȯÀÚ°¡ sympathomimetic aminesÀ» ÀÚ°¡
Åõ¿©ÇÔÀ¸·Î½á ¹ß»ýÇÏ´Â °ÍÀÌ´Ù.
¨é intracranial lesion(ƯÈ÷ posterior fossa tumor or SAH)ÀÌ hypertensionÀ» ÀÏÀ¸Å³ ¼ö
ÀÖÀ¸¸ç catecholamine ¹× catecholamine metabolites excretionÀÌ Áõ°¡µÉ¼ö ÀÖ´Ù.
7. Ä¡·á
1) preop management
ÀÏ´Ü Áø´ÜÀÌ È®Á¤µÇ¸é phenoxybenzamine(noncompetitive ¥á-receptor blocker)À¸·Î
Ä¡·á¸¦ ½ÃÀÛÇÑ´Ù. 10mg q 12hrÀ¸·Î ½ÃÀÛÇÏ¿© Ç÷¾ÐÀÌ Á¶ÀýµÇ°í paroxysmÀÌ ¾ø¾îÁú ¶§±îÁö
¼öÀϸ¶´Ù 10-20mg¾¿ Áõ·®ÇÑ´Ù. ´ëºÎºÐ ȯÀÚ´Â 40-80mg»çÀ̰¡ ÇÇ·áÇÏ´Ù.
¼ö¼úÀü¿¡ phenoxybenzamineÀ» Àû¾îµµ 10-14Àϰ£ Åõ¿©Çϵµ·Ï ÇÑ´Ù. phenoxybenzamine
°°Àº ¥á-blocker¸¦ ±¸ÇϱâÀü±îÁö oral prazocin or noncompetitive IV pentolamineÀ¸·Î
Ä¡·áÇÒ¼ö ÀÖ´Ù.
nitroprusside, calcium channel blocker´Â ¥á-blockade°¡ À¯µµµÈ ÈÄ¿¡¸¸ Åõ¿©ÇÒ¼ö Àִµ¥
¸¸¾à ¸ÕÀú Åõ¿©ÇÑ´Ù¸é beta-mediated vasodilationÀÌ ±æÇ×µÇ¸é¼ Ç÷¾ÐÀÌ paradoxicÇϰÔ
Áõ°¡ÇÒ¼ö Àֱ⠶§¹®ÀÌ´Ù.
¥â-blocker´Â ¥á-blockadeÈÄ¿¡ tachycardia¸¦ Á¶ÀýÇϱâ À§ÇØ ÈçÈ÷ »ç¿ëµÇ¸ç Àú¿ë·®À̸é
ÃæºÐÇÏ´Ù.
2) tumor localization
¨ç CT or MRI : intraadrenal lesionÀ» È®ÀÎÇϴµ¥ À¯¿ë
chest³»ÀÇ extraadrenal lesionÀ» È®ÀÎÇϴµ¥´Â chest CT»ç¿ë
¨è aortography: MRI°¡ º¹°³»ÀÇ extraadrenal tumor¸¦ localizationÇϴµ¥ ½ÇÆÐÇÏ¿´´Ù¸é
aortography¸¦ ½ÃÇàÇØ º¼¼ö Àִµ¥ pheochromocytoma´Â ¸¹Àº aberrant artery·ÎºÎÅÍ
supply¸¦ ¹Þ±â ¶§¹®ÀÌ´Ù.
¨é venous sampling: CT, MRI, aortography°¡ ¸ðµÎ ½ÇÆÐÇÏ¿´´Ù¸é ¼·Î ´Ù¸¥ level¿¡¼
venous samplingÇÏ¿© catecholamine gradient¸¦ È®ÀÎÇÑÈÄ selective aortography³ª
CT, MRI¸¦ ´Ù½Ã °Ë»çÇØº¼¼ö ÀÖ´Ù.
¨ê 131I-MIBG scan
extraadrenal pheochromocytoma¸¦ localizationÇÏ´Â °Í»Ó¸¸ ¾Æ´Ï¶ó
biochemical confirmationÀÌ È®Á¤ÀûÀÌÁö ¾ÊÀ»¶§ CT¿¡¼ ¹ß°ßÇÑ lesionÀ» Ư¼ºÀ» °áÁ¤
Áþ´Âµ¥ À¯¿ëÇÏ´Ù.
¨ë percutaneous needle aspiration: ±Ý±â
3) surgery
surgical mortality < 2-3%
hypertension & cardiac arrhythmia´Â ¸¶ÃëÀ¯µµ, ±âµµ»ð°ü, tumor manipulation½Ã¿¡
°¡Àå Àß »ý±ä´Ù. IV phentolamineÀº BP controlÇϴµ¥ ÃæºÐÇÏÁö¸¸ ¶§·Î´Â nitroprusside°¡
ÇÊ¿äÇÒ ¼öµµ ÀÖ´Ù. tachydardia¿Í ventricular ectopy¸¦ controlÇϱâ À§ÇØ propranololÀ»
»ç¿ëÇÑ´Ù.
4) pheochromocytoma in pregnancy
ÀÓ½ÅÃʱ⿡´Â phenoxybenzamineÀ» ÁغñÇÑÈÄ °¡´ÉÇÑ Áø´ÜÈÄ »¡¸® ¼ö¼úÇÑ´Ù.
ÀϺη¯ À¯»ê½Ãų ÇÊ¿ä´Â ¾øÀ¸³ª ¼ö¼ú ÀÚü·Î ÀÎÇØ ÀÚ¿¬À¯»êµÉ¼ö ÀÖ´Ù.
3rd trimester¿¡¼´Â adrenergic blocking agent°¡ »ç¿ëµÉ¼ö ÀÖ´Ù.
žư¡ ÃæºÐÈ÷ Å©¸é C-secÈÄ tumor extirpationÇÑ´Ù.
antepartum diagnosis½Ã »ê¸ðÀÇ »ç¸Á·üÀº nonpregnant pheochromocytomaº¸´Ù ³·Áö¸¸
žÆÀÇ »ç¸Á·üÀº ¿©ÀüÈ÷ ³ô´Ù.
5) unresectable and malignant tumors
malignant pheochromocytoma´Â ÁÖ·Î retroperitoneum¿¡ À§Ä¡Çϸç bone & lungÀ¸·Î
metastasis Àß ÇÑ´Ù. radiotherapy¿¡ resistantÇÏÁö¸¸ CTx¿Í combinationÇÏ¿© Á¦ÇÑÀûÀ¸·Î
¼º°øÀ» º¸À̱⵵ ÇÑ´Ù.
131I-MIBG´Â uptake°¡ Àß ¾ÈµÇ¹Ç·Î Ä¡·á¿¡ µµ¿òÀÌ ¾ÈµÈ´Ù.
8. Prognosis & follow-up
¼ö¼úÈÄ 5³â »ýÁ¸·üÀº 95%ÀÌ»óÀ̸ç Àç¹ß·üÀº 10% ¹Ì¸¸ÀÌ´Ù.
¼º°øÀûÀÎ Ä¡·áÈÄ catecholamine excretionÀº 2ÁÖ³» Á¤»óȵȴÙ.
malignant pheochromocytomaÀÇ 5³â »ýÁ¸·üÀº 50% ¹Ì¸¸ÀÌ´Ù. ¿ÏÀüÇÑ ÀýÁ¦ÈÄ 3/4¿¡¼
°íÇ÷¾ÐÀÌ ¿ÏÄ¡µÇ³ª ³ª¸ÓÁö 1/4¿¡¼´Â °íÇ÷¾ÐÀÌ Àç¹ßÇÏÁö¸¸ ÀϹÝÀûÀÎ Ç×°íÇ÷¾Ð¾àÁ¦·Î Àß
Á¶ÀýµÈ´Ù. ÀÌ·± ȯÀÚµéÀº underlying essential hypertensionÀ̳ª catecholamine-induced
irreversible vascular damage°¡ ÀÖ¾î °íÇ÷¾ÐÀ» Áö¼ÓÀûÀ¸·Î ÀÏÀ¸Å°´Â °ÍÀÌ´Ù.