褐色細胞腫におけるTyramine試験の検討

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Although the chemical determination of catechol-amines and their metabolites in urine provides the most reliable means of diagnosis of pheochromo-cytoma, the procedures are not so easy as to be used in every hospital. Many pharmacological tests therefore have been developed and used for routine screening purpose. However, all these tests occasionally give false-positive or -negative results, and more or less serious side reactions also limit the value of these tests. In 1964, Engelman et al. developed a new provocative test, tyramine test, for the diagnosis of pheochromocytoma. These authors emphasized that this was the most accurate and reliable test without undesirable side reactions. We have tried this test in patients with pheochromo-cytoma and found that considerably high false-ship between pressor response to tyramine and negative results were encountered in patients with paroxysmal type of pheochromocytoma. Materials and Methods There were 10 patients with surgically proved pheochromocytoma including 6 paroxysmal and 4 sustained type of hypertension. Four of them were familial case and the medullary thyroid carcinoma was found in 3 of these 4 cases. As control subjects, 15 patients with essential hypertension, 3 with primary aldosteronism, 4 with renovascular hypertension and 5 with hyperthyroidism were also studied. Prior to the test, the patients received no medication for 2 weeks or more. Tyramine test was performed in the way originally described by Engelman et al. Results Positive response to tyramine was found in 7 of 10 (70%) patients with pheochromocytoma. Three of these patients were so responsive to tyramine that they had systolic pressure response of more than 20mmHg to doses of 250 and 500μg of tyramine, and they were not tested at higher dose levels. They were all sustained type. Contrarily, only 3 of 6 (50%) patients with paroxysmal type of pheochromocytoma gave positive results. Three of 4 familial cases re-sponded positively to tyramine (75%). Two of these three positive cases had sustained hypertension. Remaining 2 familial cases had paroxysmal hypertension and one of them showed positive tyramine test. There was significant relationship between pressor response to tyramine and urinary excretion of noradrenaline, but not urinary adrenaline levels. Our study revealed that the paroxysmal type of pheochromocytoma excreted lower catecholamine than did the sustained type. Further comparisons on the basis of duration of clinical course or patient's age or Four of them sex showed no correlation.
1972-05-20

褐色細胞腫におけるTyramine試験の検討

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