Intrathoracic chemodectoma with noradrenaline secretion.

Abstract

Tumours arising in the chemoreceptor system are termed chemodectomas. Intrathoracic chemodectoma is a rare tumour, only 74 Case reportA 38-year-old housewife was referred to the cardiac unit for investigation of hypertension which had persisted since her first pregnancy three years previously. She was a non-smoker and was not taking the contraceptive pill. At presentation the blood pressure was 160/110 mm Hg. There was no radiofemoral delay or renal bruits and both optic fundi were normal. The chest radiograph and tomograms showed a lobulated mass in the paravertebral region at the level of T6/T7 (fig 1 a, b) which appeared highly vascular at aortography. Computerised axial tomography was performed to define the relationship to the vertebral bodies, and this revealed that the mass entered the body of the vertebra of T6 (fig 2). Two 24-hour urine collections were analysed for urinary catecholamines and showed grossly raised normetadrenaline (NMA): 3323 ,ug/24 hours and 2802 gg/24 hours (NR: 204-585). Urine homovanillic acid (HVA) and metadrenaline (MA) excretions were normal.Operation was performed and the arterial pressure and ECG were monitored continuously. Blood pressure was controlled by an intravenous infusion of phentolamine 1 mg/ml at 3 mg/min, supplemented by intravenous boluses of 2 mg propranolol, especially when the tumour was being manipulated. After removal of the tumour there was a fall of the systolic blood pressure to 80 mm Hg which responded to blood transfusion, and thereafter the blood pressure remained stable.

Hyperplasia of the carotid body

“…In two consecutive generations of a family reported by Chedid and Jao (1974), 1 1 tumours occurred in six subjects, no fewer than four of whom had chronic obstructive lung disease with persistent hypoxaemia and hypercarbia. Systemic hypertension has been reported in association with chemodectomas of lung (Fawcett and Husband, 1967;Nigam et al, 1981) and…”