Pheochromocytoma

"rare tumor in the adrenal gland"

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Pathophysiology

A pheochromocytoma is a rare, tumor that develops in the adrenal gland. Usually, it affects only 1 but can affect both, and is usually benign or noncancerous.  The tumor releases hormones that cause high blood pressure either chronically or episodically. This can, if left untreated, cause severe damage to other systems, mainly the cardiovascular system.

 

Etiology

Although the causes of pheochromocytoma are unknown, we do know that the tumor develops in the chromaffin cells in the center of the adrenal gland. These cells are responsible for excreting the catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) which help regulate many things including heart rate, B/P and Blood sugar.


The catecholamines trigger your fight or flight response, and in turn raise your B/P, and pulse and boost other systems to heighten your response time. A pheochromocytoma causes an irregular and excessive release of these hormones.

 

Lab & Diagnostics

Labs and diagnostics for Pheochromocytoma include:

  • 24-hour Urine Test

  • Blood Test

  • Imaging Test:  

    • X-ray

    • MRI 

    • MIBG

    • PET, to visualize if a tumor is present

  • Genetic Testing

 

Signs & Symptoms

S/S of Pheochromocytoma include:

  • High blood pressure

  • Diaphoresis (heavy sweating)

  • Headache

  • Rapid heart rate

  • Tremors

  • Pallor (paleness)

  • Dyspnea (shortness of breath)

 

Risk Factors

Risk factors for Diabetes Insipidus include:

  • Genetics

  • Tumors at multiple sites

  • Cancers in this area

  • Triggers:

    • Anxiety or Stress

    • Position Changes

    • Labor and Delivery

    • Surgery

    • FOOD HIGH IN TYRAMINE

 

Treatment

The primary mode of treatment is the removal of the tumor. Most of the time, the entire adrenal gland with the tumor is removed surgically.


Pre-Op Medications: 

  • Alpha-blockers: to keep smaller arteries and veins open and relaxed

  • Beta-blockers: to get the heart to beat slower and with less force

  • High Salt Diet: Alpha and Beta-blockers will dilate the blood vessels causing the amount of fluid in the vessels to decrease. This diet will draw more fluid inside preventing dangerously low blood pressure.

 

Nursing

Interventions

Nursing interventions for pheochromocytoma include:

  • Monitor vitals (B/P and HR),

  • Monitor for hypertensive crisis (>180 systolic or >120 diastolic),

  • Monitor for chest pain, neuro status, EKG changes, hyperglycemia.

  • Provide a calm, cool environment with very little stimulation to prevent an increase in B/P.

  • Educate the patient on the disease process and prevention measures for triggers.

  • Avoid FOODS HIGH IN TYRAMINE! Including aged cheese, aged meat, milk etc.

 

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