A Case of Malignant Pheochromocytoma Showing Marked Elevation of Blood Pressure at the Supine Position Hitoshi Sakuragi 1 , Masashi Horimoto 1 , Takashi Takenaka 1 , Katsushige Yamashiro 2 , Toshio Yokoi 3 , Kenjiro Kikuchi 4 1Division of Cardiology, National Sapporo Hospital 2Division of Pathology, National Sapporo Hosopital 3Yokoi Clinic of Internal Medicine 4Department of First Internal Medicine, Asahikawa Medical College Keyword: 褐色細胞腫 , 仰臥位 , 高血圧 , pheochromocytoma , supine position , hypertension pp.1043-1047
Published Date 1999/10/15
DOI https://doi.org/10.11477/mf.1404901983
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We describe a 58-year-old male patient with malig-nant pheochromocytoma showing marked elevation of blood pressure at the supine position. He was admitted to the hospital presenting palpitation, headache and sweating associated with striking hypertension up to 250/110 mmHg but without tachycardia. Serum and urinary values of noradrenalin and dopamine were markedly elevated as well as urinary values of vanillyl-manderic acid and normetanephrine. Enhanced comput-ed tomography of the abdomen revealed an enlarged right adrenal gland and an osteolytic tumor mass in the right iliac bone.

By ambulatory blood-pressure monitoring, marked and continuous nocturnal elevation of blood pressure around 200/100 mmHg was noted. As the patient fre-quently had the chief complaints at the supine position, the influence on blood pressure of a posture change from sitting to a supine position was examined. Pronounced elevation of blood pressure from 160/80 mmHg at sit-ting to 270/120 mmHg at a supine position was documented with an increment in serum value of nor-adrenalin. The blood pressure declined to the baseline value after a posture change to sitting.

Following right adrenarectomy, the serum value of noradrenalin was markedly reduced but still exceeded its normal value due to the presence of the metastatic tumor. However, the nocturnal elevation of blood pres-sure disappeared and a postural change from sitting to a supine position did not provoke elevations of blood pressure or serum noradrenalin value. Thus, we conclud-ed that the blood pressure elevation at a supine position was caused by a release of adrenalin from the adrenal tumor. The patient subsequently underwent radiother-apy for the metastatic bone tumor.

An abrupt elevation of blood pressure by an increment in abdominal pressure has been well recognized in pheo-chromocytoma at certain postures such as the lateral position, prone position or on bending, at defecation or urination. However, elevation of blood pressure elicited at a supine position has not yet been described in pheo-chromocytoma. The present case demonstrated that a supine position could cause a striking elevation of blood pressure in pheochromocytoma via the release of nor-adrenalin from an adrenal tumor.

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