Phaeochromocytoma

Question 1

Airway and breathing

Answer 1

as per usual

Question 2

Circulation

Answer 2

Look: sweating
Listen: s1, s2, 0
Feel: CRT, pulses, apex

ECG - sinus tachy
HR
BP (increased)

Bloods: FBC, UEs, LFTs, TFTs, CRP, T4, cortisol, ACTH, renal, aldosterone, 24hour urine catecholamine

IV access
- Get help; take to ICU
- ALPHA BLOCKADE FIRST (unopposed beta-blockade may worsen ↑BP) Start with short-acting, IV alpha-blocker (e.g. phentolamine 2–5 mg IV) Repeat to maintain safe BP
- When BP controlled, give long-acting alpha-blocker: phenoxybenzamine 10 mg OD PO (increase by 10 mg as needed, up to 30 mg BD PO)
- A beta 1-blocker may also be given at this stage to control any tachycardia or myocardial ischaemia/dysrhythmias.

Surgery: elective, 4–6 weeks later to allow full alpha-blockade and volume expansion. When admitted for surgery the phenoxybenzamine dose is increased until significant postural hypotension occurs.

Question 3

Presentation

Answer 3