Phenochromocytoma

Question 1

What is phenochromocytoma?

Answer 1

• Rare condition
• caused but benign tumor in the adrenal medulla
• Produces excess catecholamines (epinephrine & norepinephrine)
• Severe HTN

Question 2

Clinical manifestations of Pheochromocytoma I

Answer 2

• severe HTN 200/150 is their baseline/normal
• Hypermetabolic: Catecholamines realeased all the time. Losing weight, sweating.
• Postural Hypotension
• Hyperglyceima (polyuria)
• HA & visual disturbances

Question 3

Clinical manifestations of Pheochromocytoma II

Answer 3

• Catecholamines released all the time*
• Tremors, pallor, perspiration, face flushing
• Diarrhea, vomiting, abdominal pain
• emotional changes, psychotic behavior

Question 4

Diagnostic testing for Pheochromocytoma

Answer 4

MOST reliable diagnostic measure

• urinary metanephrines (Catecholamines metabolites)
• 24 Urine collection: Creatinine & fractional Catecholamines
• CT scan & MRI of adrenal gland: look at tumor
• clonidine suppression test

Question 5

Clonidine suppression test

Answer 5

Distinguished between essential HTN & Pheochromocytoma

• Essential HTN= BP ⬇️
• Pheochromocytoma = BP does not drop
• Clonidine dilates muscles surrounding vessel
• Clonidine has not effect and this indicates a tumor
• Clonidine fools brain into suppressing adrenal gland production of adrenaline and noradrenaline. Closes the negative feedback loop of adrenal cortex (brain sends signal to organ)

Question 6

Pharmacological management of Pheochromocytoma

Answer 6

Alpha - Adrenergic Blocking agents : Terazosin, Prazosin
- 1st line used to inhibit catecholamine on BP
- Controls BP 1-2 weeks into start
- 7-10 days preoperatively to prevent intraoperative HTN crisis
Catecholamine Synthesis Inhibitor: Metyrosine
- causes severe hypotension MONITOR first :24-72 hrs
Calcium Channel Blocker: Cardene
- control HTN & catecholamine symptoms

Question 7

Surgical treatment

Answer 7

Adenalectomy

• Removal of adrenal gland
• If none of the medications work

Question 8

Interventions for Pheochromocytoma

Answer 8

• CALM QUIET ENVIRONMENT!
• Bed rest, Elevate HOB 45
• Monitor VS, ECG, Neurological status
• Eliminate stimulants (caffeine)
• Sedatives to promote relaxation
• Fluids & maintain IV infusion: 2000-3000ml for ppx Kidney stones
• I&O, LABS (BUN, Cr, & glucose)

Question 9

Additional info on Pheochromocytoma

Answer 9

• DO NOT Palpate abdomen: sudden release of catecholamine & severe HTN
• Catecholamine constant release = jittery, confused, s/s delirium
• Catecholamine constant release= hard time sleeping
• Tire Them Out! Once on Metyrosine (Catecholamine synthesis inhibitor) they can do leg lunges= exercise Big muscles