Pheochromocytoma Overview and Diagnosis
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Questions and Answers

What is the primary cause of pheochromocytoma?

  • A genetic mutation affecting kidney function.
  • An autoimmune disorder targeting chromaffin cells.
  • A bacterial infection in the adrenal cortex.
  • A tumor in the adrenal medulla. (correct)

    • Which of the following is the most dangerous immediate effect of pheochromocytoma?

  • Chronic hyperglycemia.
  • Profound bradycardia.
  • Progressive anemia.
  • Severe hypertension. (correct)

    • What is the purpose of administering α-adrenergic receptor blockers before surgery for pheochromocytoma?

  • To directly shrink the size of the adrenal tumor.
  • To stimulate insulin release and prevent hyperglycemia.
  • To control blood pressure and prevent intraoperative hypertensive crisis. (correct)
  • To reduce the risk of post-operative infection.

    • Which diagnostic test is considered the simplest and most reliable for detecting pheochromocytoma?

    <p>24-hour urine collection for fractionated metanephrines and catecholamines. (C)</p> Signup and view all the answers

    Which of the following actions should be avoided when assessing a patient suspected of having pheochromocytoma?

    <p>Palpating the abdomen. (B)</p> Signup and view all the answers

    What is the likely outcome after surgical removal of an adrenal tumor causing pheochromocytoma?

    <p>Hypertension is often cured, but may persist in some patients. (C)</p> Signup and view all the answers

    Why should β-adrenergic receptor blockers not be started before adequate α-adrenergic blockade in the treatment of pheochromocytoma?

    <p>Unopposed α-adrenergic stimulation can cause a hypertensive crisis. (D)</p> Signup and view all the answers

    Which of the following medications is known to potentially induce an attack in a patient with pheochromocytoma?

    <p>Tricyclic antidepressants (D)</p> Signup and view all the answers

    A patient with pheochromocytoma is started on α-adrenergic receptor blockers. What is an important nursing intervention related to this medication?

    <p>Teaching the patient to change positions slowly. (D)</p> Signup and view all the answers

    Which of the following conditions is commonly associated with inherited cases of pheochromocytoma?

    <p>Multiple Endocrine Neoplasia (MEN) (C)</p> Signup and view all the answers

    What medication is used to decrease catecholamine production when surgery is not an option for a patient diagnosed with pheochromocytoma?

    <p>Metyrosine (Demser) (D)</p> Signup and view all the answers

    A patient presents with hypertension and symptoms of sympathoadrenal stimulation. What is the most appropriate nursing intervention?

    <p>Referring the patient to a health care provider (HCP) for further evaluation. (A)</p> Signup and view all the answers

    What is the classic triad of symptoms for pheochromocytoma?

    <p>Severe pounding headache, tachycardia, and profuse sweating. (D)</p> Signup and view all the answers

    During a patient's 'attack' of pheochromocytoma symptoms, what is the priority nursing intervention?

    <p>Monitoring the blood pressure frequently. (C)</p> Signup and view all the answers

    In addition to monitoring blood pressure, what other parameter should be monitored in patients with pheochromocytoma to assess for potential complications?

    <p>Glucose levels to assess for diabetes. (B)</p> Signup and view all the answers

    What aspects of care are important for patients with pheochromocytoma during their treatment?

    <p>Rest, proper nutrition, and emotional support. (A)</p> Signup and view all the answers

    After adrenalectomy for pheochromocytoma, what should be emphasized to the patient regarding post-operative care?

    <p>The importance of follow-up and routine BP monitoring because hypertension may persist. (C)</p> Signup and view all the answers

    Which of the following vital sign changes should the nurse be prepared for during and after surgical removal of a pheochromocytoma?

    <p>BP fluctuations from catecholamine excesses tend to be severe (B)</p> Signup and view all the answers

    Why is the diagnosis of pheochromocytoma often missed?

    <p>The diagnosis of pheochromocytoma is often missed. (A)</p> Signup and view all the answers

    What is the most crucial aspect of post-operative care following surgical removal of a pheochromocytoma regarding blood pressure?

    <p>Monitoring blood pressure for severe fluctuations (D)</p> Signup and view all the answers

    Flashcards

    Pheochromocytoma

    A rare tumor of the adrenal medulla causing excess catecholamines.

    Catecholamines

    Hormones such as epinephrine and norepinephrine, increased in pheochromocytoma.

    Severe Hypertension

    Dangerous high blood pressure occurring due to pheochromocytoma.

    Episodic Symptoms

    Sudden episodes of severe headache, palpitations, and sweating.

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    Triggers of Attacks

    Factors like trauma, stress, and certain drugs can induce attacks.

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    24-Hour Urine Test

    Diagnostic test measuring catecholamines and metabolites in urine.

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    Alpha-Blockers

    Medications given before surgery to control blood pressure.

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    Beta-Blockers

    Medications used after adequate alpha blockade to control tachycardia.

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    Surgical Removal

    Primary treatment for pheochromocytoma, often laparoscopic.

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    Orthostatic Hypotension

    Low blood pressure upon standing, a potential side effect of treatment.

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    Metyrosine (Demser)

    A medication used to decrease catecholamine production in pheochromocytoma.

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    Classic triad of pheochromocytoma

    Severe headache, tachycardia, and profuse sweating related to catecholamine excess.

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    Hypertension referral

    Patients with hypertension and symptoms should be evaluated for pheochromocytoma.

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    Blood pressure monitoring

    Essential in managing patients with catecholamine excess during episodes.

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    Surgical care for adrenalectomy

    Care protocols similar to those for lower adrenal tumors during surgery.

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    Assessing diabetes

    Monitor glucose levels in patients with pheochromocytoma for potential diabetes.

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    Emotional support

    Providing psychological assistance to patients during treatment of pheochromocytoma.

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    Monitoring glucose levels

    Regular checks are important for managing overall health in pheochromocytoma patients.

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    Post-surgery follow-up

    Important for monitoring persistent hypertension after tumor removal.

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    Study Notes

    Pheochromocytoma Overview

    • Rare tumor in the adrenal medulla, affecting chromaffin cells
    • Causes excess catecholamine (epinephrine, norepinephrine) production
    • Most immediate danger is severe hypertension
    • Untreated, can lead to complications like encephalopathy, diabetes, cardiomyopathy, multiple organ failure, and death
    • Most common in young to middle-aged adults
    • Can be inherited in persons with MEN (multiple endocrine neoplasia) syndromes
    • Characterized by episodic, severe hypertension
    • Often accompanied by pounding headache, tachycardia, palpitations, profuse sweating, abdominal or chest pain
    • Attacks triggered by trauma, pressure on tumor, stress, various drugs

    Diagnostic Considerations

    • Key diagnostic test: measurement of urinary fractionated metanephrines (catecholamine metabolites) and fractionated catecholamines and creatinine (typically 24-hour urine collection)
    • Finding are elevated in at least 95% of cases
    • Serum catecholamines also increased during hypertensive "attacks"
    • Imaging methods (CT and MRI) used to detect tumors
    • Crucial to avoid palpating the abdomen - this could trigger sudden catecholamine release causing severe hypertension

    Management and Treatment

    • Primary treatment is surgical removal of the tumor

    • Pre-operative management crucial to control blood pressure (BP) and prevent intraoperative hypertensive crisis

    • Alpha-adrenergic blockers (e.g., doxazosin) are started 10–14 days before surgery to reduce blood pressure

    • Beta-blockers (e.g., propranolol) are used after adequate alpha-blockade to manage tachycardia and dysrhythmias; starting beta-blockers too early can lead to a hypertensive crisis

    • Post-operative considerations

      • BP fluctuations are common and must be monitored closely
      • If surgery is not an option, metyrosine (Demser) may be used to reduce catecholamine production
      • Hypertension sometimes persists even after surgery (10-30% of cases)
      • Follow-up appointments and regular BP monitoring is essential for long-term management.

    Nursing Considerations and Case Finding

    • Nurses play a vital role in early detection

    • Patients with hypertension and symptoms of sympathoadrenal stimulation should be assessed by a healthcare professional

    • Look for classic triad symptoms (severe headache, tachycardia, profuse sweating)

    • Assess blood pressure frequently during attacks

    • Ensure patient comfort and provide necessary rest, nutrition, and emotional support

    • Monitor glucose levels to assess for potential diabetes

    • Post-operative care is similar to other adrenalectomy procedures

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    Description

    This quiz covers the essential aspects of pheochromocytoma, a rare tumor of the adrenal medulla that leads to excess catecholamine production. Participants will learn about its symptoms, dangers, and the key diagnostic considerations, including urinary and serum tests. Gain a clearer understanding of this condition and its management.

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