Pulmonary Arterial Hypertension Associated with a肺动脉高压与A。.pptVIP

Pulmonary Arterial Hypertension Associated with a Neuroendocrine Pancreatic Tumor Successfully Treated with Bosentan and Fluoxetine By Paul Strachan MD*, Subani Chandra MD**, Sophy Dedopoulos NP***, Arunabh Talwar MD*** *Division of Pulmonary Critical Care, SUNY Stony Brook Medical Center, Stony Brook, NY ** Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY *** Division of Pulmonary, Critical Care and Sleep Medicine, North Shore-Long Island Jewish Health System, Manhasset, NY Disclosure Consulting and speakers fees: Encysive Pharmaceuticals. Stock holdings: Pfizer Inc. Introduction There is current interest in the link between Pulmonary Arterial Hypertension (PAH) and Serotonin. We present a case of a patient with a serotonin secreting pancreatic islet cell tumor who developed PAH. His symptoms significantly improved after treatment with bosentan and fluoxetine. The Case The patient is a 39 year old male. He initially presented in 1998, at age 31, with palpitations. Laboratory evaluation revealed an elevated Alkaline Phosphatase. Ultrasound of the Abdomen showed a large mass in the pancreas. The Mass Patient had an exploratory laparotomy. The mass was encasing the superior mesenteric artery vein. Not resectable Biopsies were obtained. Stains were consistent with a Neuroendocrine Tumor (Islet Cell) of the Pancreas. From Then to Now He was followed with serial CT scans. The mass remained stable in size, therefore chemotherapy was never initiated. Throughout this time period his only symptoms were occasional diarrhea and facial flushing. The Present Illness In January 2004, the patient noted increasing dyspnea on exertion. At his PMD, an echocardiogram was notable for pulmonary hypertension. Over the next three months, he had two episodes of syncope and worsening dyspnea. Hospitalized after the second syncope. Medical History PMH PNA 12 years ago Systemic HTN Dx 1 year prior to the mass being detected. PSH Exp Lap (to biopsy