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Pheochromocytoma Chapter 42

Pheochromocytoma functional chromaffin cells produce excess catecholamines-stimulate autonomic nervous system-catecholamines, adrenal and, norepinephrine rain.
Pheochromocytoma catecholamine producing tumor cells, usually found in the adrenal Mejia law daddy is the adrenals are little hats on top of the kidneys remember.
Adrenal glands are divided into and outer cortex and an inner would do the; each area see creeds specific hormones.
What does the adrenal mood do less secrete catecholamines-epinephrine and norepinephrine for the fight or flight system.
Where can catecholamine producing tumors be found in the body usually in the adrenal medulla, but may be found throughout the body- including the lung, bladder, abdomen, and brain and they will secrete catecholamines from these sites
Pheochromocytoma is this tumor benign? Usually, but it can be a malignant tumor.
Pheochromocytoma - typical triad of symptoms patients with functioning tumors of the adrenal Medulla-hypertension with a triad of symptoms-headache, diaphoresis, and TACHYCARDIA (palpitations)
Pheochromocytoma HYPERGLYCEMIA -due primarily to catecholamine stimulation of lipolysis (breakdown of stored fat) leading to high levels of free fatty acids and the subsequent inhibition of glucose uptake by muscle cells.
Pheochromocytoma stimulation of beta-adrenergic receptors leads to glycogenolysis and gluconeogenesis and thus elevation of blood glucose levels).
Pheochromocytoma HYPERTENSION excess catecholamines cause hypertension, which may be intermittent or persistence.
Pheochromocytoma paroxysmal or sustain hypertension (SEVERE) with severe headache, tachycardia, flushing and profuse diaphoresis
Pheochromocytoma Five H's - hypertension, headache, hyperhidrosis (excessive sweating); hypermetabolism and hyperglycemia
Pheochromocytoma HYPERTENSIVE EPISODE extremely high blood pressure-may reach 300/180 - could cause shock, stroke, renal failure, dysrhythmias, dissecting aortic aneurysm and may result in death.
Pheochromocytoma S/S - other signs and symptoms palpitations, pain in the chest or abdomen with nausea and vomiting, heat intolerance, weight loss, tremors
Pheochromocytoma - Diagnostic tests 24-hour urine collection for INCREASED vanillylmandelic acid (VMA) - a byproduct of catecholamine metabolism
Pheochromocytoma - Diagnostic tests INCREASED metanephrine, INCREASED catecholimines (normal range 14 mcg/100mL0
Pheochromocytoma - Diagnostic tests tumor can be located by CT and MRI.
Pheochromocytoma - Treatment medications to prevent or treat the severe hypertension
Pheochromocytoma - Treatment block alpha adrenergic receptors -phentalamine (Regitine, Rogitine)
Pheochromocytoma - Treatment Propranolol (Inderal) - beta blocker
Pheochromocytoma - Test phentalamine (Regitine, Rogitine) - used as an aid in the diagnosis and treatment due to phenol chromos site, prior to enduring surgery
Pheochromocytoma - another test Clonidine (Catapres) - usually, this drug suppresses catecholamines-therefore, if drug is administered and catecholamines are not suppressed, they are coming through tumor.
Pheochromocytoma symptomatic treatment is initiated if surgical removal is not possible
Pheochromocytoma complications-hypertensive crisis-can be severe-hypertensive retinopathy and nephropathy; cardiac enlargement; dysrhythmias, CHF, MRI, stroke
Pheochromocytoma complications-hypertensive crisis - dissecting aortic aneurysms due to extremely high blood pressure
Pheochromocytoma - monitor IMPORTANT - get accurate BP; use same arm, need orthostatic BP, be sure to use a palpable estimate an appropriate size of cough
orthostatic BP patient lies flat for 10 min.-take initial BP and heart rate; we've BP cuffs. I; patient sits on edge of bed-take another BP; then, have patient standing at the side of the bed
Pheochromocytoma - pre-op maintain medically-there is great risk for hypertensive crisis
Pheochromocytoma - prost-op post op, there is risk for hypotension - also limit activity
Pheochromocytoma - IMPORTANT - monitor for hyperglycemia-zero Lupo close levels should be watched and hydration (remember 5 H's - )
Pheochromocytoma - **IMPORTANT** DO NOT PALPATE ABDOMEN - identify and avoid stimuli that can precipitate a hypertensive crisis pressure on the abdomen could result in the release of catecholamines
Pheochromocytoma - **IMPORTANT** DO NOT PALPATE ABDOMEN - Adrenal glands are located on top of the kidneys palpating abdomen could set off release of catecholamines
Pheochromocytoma - EMERGENCY MEDS prepare to administer a beta atria allergic blocking agent to control hypertension - Propranolol (Inderal)
Pheochromocytoma - dyads-high calories, vitamins, minerals
Created by: jhrobins99