Pheochromocytoma presentation

PHEOCHROMOCYTOMA

Submitted to: Mrs. Potenciana A. Maroma

Prepared by;Mones, Karen Joy T.Pimentel, Moriel N.

BSN 3Y1-2

Objectives of the Reporter

To discuss the topic and also for able to know of the student the definition, sign and symptoms, complication, pathophysiology, pharmacological therapy, medical management, surgical management and the nursing management for the pheochromocytoma.

PheochromocytomaAre a type of tumor of the adrenal

glands that can release high levels of epinephrine and norepinephrine.

Signs and symptoms The most common is the 5H’s with the attack subsiding

in less than one hour. Tumors may grow large, but most are smaller than 10 cm. Are those of sympathetic nervous system hyperactivity, including:

5 H’s Hypertension Headache Hyperhidrosis Hypermetabolism Hyperglycemia

Skin sensationsFlank painElevated heart rateElevated blood pressure PalpitationsAnxiety often resembling that of a panic attack.

DiaphoresisHeadaches – most common symptom

PallorWeight lossElevated blood glucose level

Complications

The massive release of catecholamines in pheochromocytoma can cause damage to cardiac cells (myocytes). This damage may be due to either compromising the coronary microcirculation or by direct toxic effects on the heart cells.

Pathophysiology

Adrenal medulla

Tumor

Catecholamine

↑epinephrine and norepinephrine

Hypertensive

retinopathy

Hypertensive

neuropathy

Myocarditis

Cerebral hemorrhag

e

Diet of the Patient

o High Vitamino High Calorieo High Mineralo High Calciumo Restrict Caffeine

Pharmacological Therapy

Pharmacological TherapyAlpha adrenergic Blocking Agentsphentolamine (Regitine) – for smooth muscle relaxant

sodium nitroprusside (Nipride) – to lower the blood pressure quickly.

Beta Adrenergic AgentsPropranolol (Inderal) – used in patients with cardiac dysrhythmias or those not responsive.

Long Acting Alpha Blockersphenoxybenzamine (Dibenzyline) – may be used when blood pressure is stable to prepare the patient for surgery. 

Diagnostic and Laboratory Test

Catecholamines Test A 24 hours urine collection. Measures the amount of the

hormones epinephrine, norepinephrine, metanephrine, and dopamine in the urine.

These catecholamines are made by nerve tissue, the brain, and the adrenal glands.

CT Scanning

Has accuracy of 85-95% for detecting adrenal masses with a spatial resolution of 1 cm or greater.

MRI

Preferred over CT scanning in children and pregnant or lactating women; has reported sensitivity of up to 100% in detecting adrenal pheochromocytoma.

PET Scanning

A promising technique for detection and localization of pheochromocytoma

Medical Management

During an episode or attack of hypertension, tachycardia, anxiety and other symptoms of pheochromocytoma, the patient is placed on the bed rest with the head of the bed elevated to promote an orthosthatic decrease in blood pressure.

Surgical Management

ADRENALECTOMYthe definitive treatment for pheochromocytoma it is a complete surgical removal of the affected adrenal gland(s).

ADRENALECTOMY SURGERY

o The patients need to be well hydrated before during, and after surgery to prevent hypotension

o Several days after surgery, urine and plasma levels of catecholamines and their metabolites are measured to determine whether surgery was successful.

Nursing Management Monitor ECG changes Monitor Vital Sign especially BPMonitor urine tests for glucose and

acetone.Avoid smoking and stimulants

(coffee and tea)Provide high-calorie, well-balanced

diet

Monitor Blood glucose level Monitor fluid and electrolyte

balance Promote rest and decrease

stressful stimuliAdminister medications as ordered.Antihypertensive SedativesAntidhysrhythmics

For clients on 24-hour VMA testing--> instruct to avoid vigorous and prolonged exercise and intake of coffee, tea, chocolate, bananas, and vanilla-flavored food at least two days prior to and during urine collection

For clients with an adrenalectomy, observe for BP changes-- clients are at risk for shock due to a drastic drop in catecholamine levels.

Provide client teaching on possibility of lifelong steroid replacement (for bilateral adrenalectomy).

“The more that you read, the more things you will know.

The more that you learn, the more places you'll go.” -Dr. Seuss-