c15. desafios de um caso de carcinóide brônquico

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ID: 148786
2003
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Abstract
Os carcinóides pulmonares constituem 1 a 2% de todos os tumores pulmonares e 10% de todos os carcinóides. Encontram-se associados a alterações endócrinas decorrentes da sua capacidade em produzir uma grande variedade de péptidos e hormonas biologicamenteactivas.Os AA apresentam o caso de um homem, 52 anos, caucasiano, que recorre ao Serviço de Urgência por expectoração hemoptóica inaugural. Referia como único antecedente HTA com aproximadamente 1 ano de evolução, de difícil controlo sob medicação com indapamida.Apresentava, como única alteração ao exame objectivo, hipertensão sistodiastólica (180/130 mmHg) e analiticamente, hipocaliémia (3,1 mEl/l). A telerradiografia do tórax foi considerada normal e o exame bacteriológico directo da expectoração foi negativo. Tendo em vista o esclarecimento do quadro é internado no Serviço de Medicina onde realiza estudo dirigido ao distúrbio endócrino, incluindo prova de estimulação com fludrocortisona, situando-se todos estes resultados nos valores normais. Realiza ainda TAC abdominal e torácica nos quais também não são vistas alterações relevantes.Tem alta clinicamente bem, com TA controlada com atenolol 100 mg dia e nifedipina 10 mg 3id e sem evidência de perdas hemáticas. Por persistência de esporádicos episódios de expectoração hemoptóica, faz broncofibroscopia que revela a obstrução completa do LSE por neoformação tipo cereja, muito sangrante ao toque do broncoscópio. A citologia do escovado mostra carcinoma pouco diferenciado, de grandes células. É proposto para lobectomia superior esquerda, que decorre sem complicações. O exame histológico da peça operatória revela a presença de carcinóide típico.Actualmente o doente encontra-se assintomático, com perfil tensional normal, sem necessidade de recurso à terapêutica antihipertensora.Os AA não se encontraram, na literatura revista, uma clara referência à associação entre hipertensão/hipocaliémia e carcinóide broncopulmonar, que é de admitir neste caso. : One to 2% of all lung tumors are carcinoid tumors. Bronchopulmonary carcinoid tumors are reported to represent 10% of all carcinoid tumors. These neoplasms are capable of producing a variety of substances including biologically active peptides and hormones, causing some well established syndromes.The authors report a case of a 52 year old man, caucasian, submitted to the ER with hemoptysis beginning in the same day. He had a history of hypertension, poorly controlled, known for a year, under medication with indapamid.During his admission, a high blood pressure (180/130 mmHg) and hypokalemia (3, 1 mEq/l) were registered. The thorax x-ray was considered normal. The direct smear (Gram and ZN) of sputum was negative.With the intent to fully understand the situation, the patient was hospitalized in the medicine department, being submitted to a wide range of exams oriented to the endocrine disturbance, including a challenge with fludrocortisone. All the results were considered normal, including the thoracic and abdominal CAT scan.He was discharged asymptomatic without any evidence of bleeding. His blood pressure was controlled with atenolol 100 mg and nifedipine 30 mg daily.The patient was submitted to flexible bronchoscopy, because he continued to suffer sporadic episodes of hemoptoic sputum. The procedure confirmed the presence of a neoplasm, cherry like, easily bleeding, completely obstructing the upper lobe bronchus. The cytology of the bronchial brushing reveals the existence of a largecell poorly differentiated carcinoma. An upper left lobectomy was performed. A typical carcinoid was detected through the pathological examination.Currently the patient is without symptoms, with a normal hemodynamic status and with no need of antihypertensive medication.In the literature reviewed, the authors didn’t find any clear reference to the association between carcinoid tumors and hypertension/hipokalemia. The main goal of this report is to discuss the possibility of existence of such an association. Palavras-chave: síndroma carcinóide, carcinóide broncopulmonar, hipertensão arterial, Key-words: bronchopulmonary carcinoid, carcinoid syndrome, arterial hypertension
Reference Key
rodelo2003revistac15. Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;E. Rodelo;A. Fernandes;B. Conde;A. Afonso
Journal the journal of applied psychology
Year 2003
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S0873215915307194
Keywords
diseases of the respiratory system

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