Pheochromocytoma Chapter 42
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| Pheochromocytoma | functional chromaffin cells produce excess catecholamines-stimulate autonomic nervous system-catecholamines, adrenal and, norepinephrine rain.
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| 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.
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| Adrenal glands are divided into | and outer cortex and an inner would do the; each area see creeds specific hormones.
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| What does the adrenal mood do less secrete | catecholamines-epinephrine and norepinephrine for the fight or flight system.
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| 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
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| Pheochromocytoma | is this tumor benign? Usually, but it can be a malignant tumor.
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| Pheochromocytoma - typical triad of symptoms | patients with functioning tumors of the adrenal Medulla-hypertension with a triad of symptoms-headache, diaphoresis, and TACHYCARDIA (palpitations)
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| 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.
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| Pheochromocytoma | stimulation of beta-adrenergic receptors leads to glycogenolysis and gluconeogenesis and thus elevation of blood glucose levels).
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| Pheochromocytoma HYPERTENSION | excess catecholamines cause hypertension, which may be intermittent or persistence.
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| Pheochromocytoma | paroxysmal or sustain hypertension (SEVERE) with severe headache, tachycardia, flushing and profuse diaphoresis
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| Pheochromocytoma | Five H's - hypertension, headache, hyperhidrosis (excessive sweating); hypermetabolism and hyperglycemia
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| 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.
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| Pheochromocytoma | S/S - other signs and symptoms palpitations, pain in the chest or abdomen with nausea and vomiting, heat intolerance, weight loss, tremors
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| Pheochromocytoma - Diagnostic tests | 24-hour urine collection for INCREASED vanillylmandelic acid (VMA) - a byproduct of catecholamine metabolism
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| Pheochromocytoma - Diagnostic tests | INCREASED metanephrine, INCREASED catecholimines (normal range 14 mcg/100mL0
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| Pheochromocytoma - Diagnostic tests | tumor can be located by CT and MRI.
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| Pheochromocytoma - Treatment | medications to prevent or treat the severe hypertension
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| Pheochromocytoma - Treatment | block alpha adrenergic receptors -phentalamine (Regitine, Rogitine)
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| Pheochromocytoma - Treatment | Propranolol (Inderal) - beta blocker
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| Pheochromocytoma - Test | phentalamine (Regitine, Rogitine) - used as an aid in the diagnosis and treatment due to phenol chromos site, prior to enduring surgery
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| 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.
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| Pheochromocytoma | symptomatic treatment is initiated if surgical removal is not possible
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| Pheochromocytoma | complications-hypertensive crisis-can be severe-hypertensive retinopathy and nephropathy; cardiac enlargement; dysrhythmias, CHF, MRI, stroke
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| Pheochromocytoma | complications-hypertensive crisis - dissecting aortic aneurysms due to extremely high blood pressure
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| Pheochromocytoma - monitor | IMPORTANT - get accurate BP; use same arm, need orthostatic BP, be sure to use a palpable estimate an appropriate size of cough
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| 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
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| Pheochromocytoma - pre-op | maintain medically-there is great risk for hypertensive crisis
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| Pheochromocytoma - prost-op | post op, there is risk for hypotension - also limit activity
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| Pheochromocytoma - | IMPORTANT - monitor for hyperglycemia-zero Lupo close levels should be watched and hydration (remember 5 H's - )
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| 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
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| Pheochromocytoma - **IMPORTANT** | DO NOT PALPATE ABDOMEN - Adrenal glands are located on top of the kidneys palpating abdomen could set off release of catecholamines
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| Pheochromocytoma - EMERGENCY MEDS | prepare to administer a beta atria allergic blocking agent to control hypertension - Propranolol (Inderal)
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| Pheochromocytoma - | dyads-high calories, vitamins, minerals
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