Nguy\u00ean nh\u00e2n n\u00e0o nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t g\u00e2y t\u0103ng g\u1ea5p \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 normetanephrine \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nam, 80 tu\u1ed5i, c\u00f3 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 lo \u00e2u, \u0111ang d\u00f9ng amlodipine, simvastatin v\u00e0 venlafaxine, xu\u1ea5t hi\u1ec7n c\u00e1c \u0111\u1ee3t lo \u00e2u v\u00e0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c?<\/p>\n
A. U h\u1ea1ch b\u00ean
\nB. T\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t
\nC. U tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn
\nD. T\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c
\nE. R\u1ed1i lo\u1ea1n lo \u00e2u<\/p>\n
\u0110i\u1ec3m then ch\u1ed1t: C\u00e1c thu\u1ed1c \u0111i\u1ec3n h\u00ecnh khi\u1ebfn x\u00e9t nghi\u1ec7m metanephrine huy\u1ebft t\u01b0\u01a1ng d\u01b0\u01a1ng t\u00ednh gi\u1ea3 l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m v\u00e0 venlafaxine.<\/p>\n
B\u1ec7nh nh\u00e2n u tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn \u0111i\u1ec3n h\u00ecnh c\u00f3 bi\u1ec3u hi\u1ec7n tam ch\u1ee9ng \u0111au \u0111\u1ea7u c\u01a1n, v\u00e3 m\u1ed3 h\u00f4i v\u00e0 nh\u1ecbp tim nhanh. Kho\u1ea3ng 50% s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng huy\u1ebft \u00e1p k\u1ecbch ph\u00e1t; h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f2n l\u1ea1i c\u00f3 bi\u1ec3u hi\u1ec7n gi\u1ed1ng nh\u01b0 t\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t ho\u1eb7c huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng.<\/p>\n
\u0110\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 metanephrine huy\u1ebft t\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 s\u00e0ng l\u1ecdc u tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn v\u00e0 u h\u1ea1ch b\u00ean (u h\u1ea1ch c\u1ea1nh th\u01b0\u1ee3ng th\u1eadn), m\u1eb7c d\u00f9 x\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 t\u1ec9 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 cao. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 85% \u0111\u1ebfn 89% \u0111\u1ed1i v\u1edbi x\u00e9t nghi\u1ec7m metanephrine huy\u1ebft t\u01b0\u01a1ng, so v\u1edbi 91% \u0111\u1ebfn 98% \u0111\u1ed1i v\u1edbi x\u00e9t nghi\u1ec7m metanephrine ni\u1ec7u 24 gi\u1edd. C\u00e1c nguy\u00ean nh\u00e2n hay g\u1eb7p g\u00e2y k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 l\u00e0 d\u00f9ng thu\u1ed1c h\u01b0ng th\u1ea7n (\u0111\u1eb7c bi\u1ec7t l\u00e0 venlafaxine v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng) v\u00e0 c\u00e1c thu\u1ed1c \u0111\u1ed3ng v\u1eadn th\u1ee5 th\u1ec3 adrenergic (nh\u01b0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb sung huy\u1ebft v\u00e0 amphetamine, c\u00e1c thu\u1ed1c n\u00e0y l\u00e0m t\u0103ng c\u1ea3 metanephrine v\u00e0 normetanephrine). Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u0103ng \u0111\u01a1n thu\u1ea7n normetanephrine nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t l\u00e0 do s\u1eed d\u1ee5ng venlafaxine, g\u00e2y t\u0103ng n\u1ed3ng \u0111\u1ed9 normetanephrine ch\u1ecdn l\u1ecdc v\u00e0 kh\u00f4ng tri\u1ec7u ch\u1ee9ng. N\u1ebfu v\u1eabn ngh\u0129 nhi\u1ec1u \u0111\u1ebfn u tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn, c\u1ea7n l\u00e0m l\u1ea1i x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng sau khi b\u1ec7nh nh\u00e2n \u0111\u1ed5i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb tr\u1ea7m c\u1ea3m.<\/p>\n
R\u1ed1i lo\u1ea1n lo \u00e2u v\u00e0 c\u01a1n ho\u1ea3ng lo\u1ea1n c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n nh\u01b0ng kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 t\u0103ng n\u1ed3ng \u0111\u1ed9 normetanephrine huy\u1ebft t\u01b0\u01a1ng. B\u1ec7nh nh\u00e2n \u00edt c\u00f3 nguy c\u01a1 m\u1eafc u tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn ho\u1eb7c u h\u1ea1ch b\u00ean do kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng (\u0111au \u0111\u1ea7u, v\u00e3 m\u1ed3 h\u00f4i v\u00e0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c), tu\u1ed5i b\u1ec7nh nh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n l\u1edbn h\u01a1n nhi\u1ec1u so v\u1edbi tu\u1ed5i m\u1eafc b\u1ec7nh trung b\u00ecnh (47 tu\u1ed5i), v\u00e0 m\u1ee9c \u0111\u1ed9 t\u0103ng n\u1ed3ng \u0111\u1ed9 normetanephrine l\u00e0 qu\u00e1 th\u1ea5p. \u1ede b\u1ec7nh nh\u00e2n u tu\u1ef7 th\u01b0\u1ee3ng th\u1eadn, n\u1ed3ng \u0111\u1ed9 metanephrine t\u0103ng g\u1ea5p 5 \u0111\u1ebfn 10 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a kho\u1ea3ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng.<\/p>\n
T\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t th\u01b0\u1eddng k\u00e8m theo t\u0103ng nh\u1eb9 n\u1ed3ng \u0111\u1ed9 metanephrine huy\u1ebft t\u01b0\u01a1ng, nh\u01b0ng v\u1eabn n\u1eb1m trong kho\u1ea3ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng.<\/p>\n
Neary NM et al. Drugs and pheochromocytoma–don’t be fooled by every elevated metanephrine. N Engl J Med 2011 Jun 9; 364:2268.<\/p>\n
Young WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 2007 Feb 9; 356:601.<\/p>\n
Eisenhofer G et al. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab 2003 Jun 6; 88:2656.<\/p>\n
Ngu\u1ed3n: NEJM.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Ca l\u00e2m s\u00e0ng Nguy\u00ean nh\u00e2n n\u00e0o nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t g\u00e2y t\u0103ng g\u1ea5p \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 normetanephrine \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nam, 80 tu\u1ed5i, c\u00f3 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 lo \u00e2u, \u0111ang d\u00f9ng amlodipine, simvastatin v\u00e0 venlafaxine, xu\u1ea5t hi\u1ec7n c\u00e1c \u0111\u1ee3t lo \u00e2u v\u00e0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c? A. U h\u1ea1ch b\u00ean […]\n","protected":false},"author":1,"featured_media":5052,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5051","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5051","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=5051"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5051\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5052"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5051"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5051"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5051"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}