He asked: "Are the patient's thyroid hormone levels normal?"

Li Xue had a headache and said: "Yes, hyperthyroidism has been ruled out..."

"The patient suddenly had difficulty breathing at noon. Was it also after the two men arrived?"

"Yes, is this related to the current cerebral hemorrhage?"

Xu Qiu nodded.

Of course there is a connection!

When leaving at noon, he saw one of the men pressing Li Qianqian's waist to listen to the fetal movements in her pregnant belly.

And this... is exactly what causes subsequent left heart failure, dyspnea and other symptoms!

The waist of the human body is where the kidneys are located.

Adrenal glands also grow next to both kidneys.

There is a common endocrine disease outside the adrenal gland - pheochromocytoma!

This is a tumor originating from the adrenal medulla, sympathetic ganglia and other parts of the body.

It releases catecholamines continuously or intermittently.

Catecholamines can quickly enhance myocardial contractility, causing sudden and sudden increases in blood pressure!

Like the shock rescue drug norepinephrine commonly used in emergency departments, epinephrine is a catecholamine substance.

For ordinary people, excessive amounts of catecholamines are used to rescue shock.

But Li Qianqian has to accept its stimulation all the time!

Simply put,

Catecholamines are like the little blue pills for cardiovascular disease.

As soon as this hormone is released, the body will immediately become extremely excited!

The man pressed his waist and inadvertently squeezed his adrenal glands, causing a sudden release of catecholamines.

As a result, Li Qianqian's cardiovascular and internal organs were like taking little blue pills, causing strong high blood pressure, accompanied by systemic sweating, tachycardia, and difficulty breathing...

In severe cases, it can even lead to left heart failure and cerebral hemorrhage!

Obviously, Li Qianqian is already very serious at the moment...

Li Xue's expression was full of astonishment, "Is this why you asked her if she had high blood pressure?"

"Um."

“Pheochromocytoma is paroxysmal hypertension!

It is not secreted normally and the blood pressure can be normal.

But if the adrenal gland is squeezed, the tumor will immediately release a large amount of catecholamines into the blood, causing a strong reaction in the body!"

Li Xue straightened out her thoughts and suddenly felt enlightened.

It turned out to be pheochromocytoma!

And...pheochromocytoma during pregnancy!

Li Xue broke into a cold sweat.

Pregnancy complicated by any disease is a severe test for both the fetus and the mother.

What's more... it's pheochromocytoma with a high risk factor!

According to literature, the overall mortality rate of such patients can reach 58%!

"I...I will arrange for blood and urine catecholamine measurements, and also report to prepare for MDT!" Li Xue spoke quickly.

mdt stands for multidisciplinary consultation.

That is, multiple departments jointly diagnose and treat, brainstorm, discuss the feasibility of surgery, and specific surgical plans.

If pheochromocytoma can be diagnosed, then Li Qianqian's risk factor will rise directly to the most dangerous category, which is by no means a problem that a single department can solve.

…

More than an hour later.

The nurse in the obstetrics and gynecology department measured Li Qianqian's blood pressure during the "attack period".

Blood pressure: 240/150mmhg.

also.

Urinary catecholamines 366.70nmol/24h (normal value: 94.5～238.3nmol/24h)

Urinary vanillylmandelic acid 182.66 μmol/24h (normal value <68.6 μmol/24h)

Urinary norepinephrine 361.69nmol/24h (normal value 80.3~164nmol/24h)

Urinary epinephrine 34.88nmol/24h (normal value 12.5~70.4nmol/24h)

All indications point to one disease: pheochromocytoma!

The directors of the consultation room, urology department, anesthesiology department, and endocrinology department all came.

Everyone’s face is solemn!

Anyone who is a surgeon knows how dangerous it is to remove pheochromocytoma.

It is located near the renal hilum, surrounded by the renal artery and renal vein, and there are also arteries passing through the tumor. The difficulty and risk of surgery are very high.

In addition, pheochromocytoma itself has extremely rich blood supply.

A little carelessness during the operation may lead to massive bleeding and the kidneys cannot be saved.

But that's not the most dangerous thing.

After all, people have two kidneys, and if one is missing, there will still be another.

The most dangerous thing is that pheochromocytoma is a powder keg that will explode when touched!

Once a pheochromocytoma is touched during surgery,

or any disturbance,

It will cause a violent reaction and release a large amount of catecholamines into the blood.

And this can cause a terrible hypertensive crisis.

The blood vessels in the brain may burst under high pressure, causing severe cerebral hemorrhage and death.

This is not over yet.

Even if the patient's life is saved during a hypertensive crisis——

When a tumor is removed, the amount of hormones secreted by the tumor into the blood decreases, which in turn causes vasodilation, causing blood pressure to plummet, leading to even more dangerous hypotension!

hypertensive crisis,

Then flipped to hypotension,

Any one of these is enough to kill the patient within minutes!

therefore.

Pheochromocytoma is rare and requires surgery by three anesthesiologists!

Moreover, every anesthesiologist must have extremely rich experience.

One of them monitors blood pressure.

The other person presses the button on the rescue medicine and administers it at any time.

The third position is responsible for taking into account the overall situation, which is often the responsibility of the director of anesthesia.

Just by making the three anesthesiologists nervous, you can see how dangerous this operation is!

…

In the conference room, everyone looked at the medical records in their hands, and the atmosphere was suffocatingly quiet.

The director of the Department of Urology was the first to speak and asked: "Can you please delay? We have a lot of pheochromocytoma treated in our department, but not many are complicated by pregnancy... Such patients often need to take ten to fourteen days of antidote."

Press medicine..."

If you don’t prepare for surgery two weeks in advance, the risk is too high!

But Director Hu shook his head and said solemnly: "I'm afraid not!

The patient's uterus is too large and has begun to compress the pheochromocytoma...

If it is delayed, there is a high probability that the fetus will still be born.

In addition, pregnant women may develop uncontrollable high blood pressure at any time, and may even progress to hypertensive crisis, at which point it is already hopeless!”

34 weeks…

A 34-week-old baby already has the conditions for premature birth.

If a cesarean section is performed to remove chromaffin cells at this time, there is still a chance to keep the mother and baby safe.

But if it takes a few days, the fetus will most likely be stillborn, and the mother will most likely not survive!

However, no one present was sure that the tumor could be removed unscathed.

At this moment, Li Xue remembered something, and his eyes moved away from the director of the Department of Urology and fell on Xu Qiu.

The others also noticed Li Xue's gaze, but shook their heads helplessly.

Even the director of brain surgery cannot perform this operation!

The medical industry is like a mountain apart.

Each department is even more distinct. It is extremely difficult to perform surgeries across departments easily.
Chapter completed!