PHEOCHROMOCYTOMA

- a tumor that is usually benign and originates from the chromaffin

cells of the adrenal medulla.

- a tumor found on adrenal medulla that secretes excessive

- amounts of catecholamines.

Catecholamines have a huge influence on how organs and tissues

work.
They cause the body to do the following:
- peak incidence is between 40 and 50 years of age
- Increase HR and BP
affecting men and women equally.
- Increase glucose by stimulating the liver to release it stores of
- May occur as single tumor or as more than one growth
glucose in the blood and blocks the role of insulin)
- It usually develops in the center (medulla) of one or both
- Increases fat metabolism for energy
- adrenal glands
- Increases basal metabolic rate
- 10% Malignant
- Increases thermogenesis
- And how you respond to stress.

Group 4:
PHEO - dark
CHROMO – color Naharah H.Ali
CYT – cell Hanin A. Macapado
OMA – Tumor
Nadjirah S. Macunte
Noryah D. Somirado

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Predisposing factors:
• Aged 40-50 years
• Familial Disorder (MEN2 type
A and B, NF-1, VHL, familial
Pheochromocytoma)
Dysfunction of various tumor
suppressor and/or oncogene
proteins
Uncontrolled proliferation of
the chromaffin cells in the
medulla of the adrenal
gland(s)
Adenoma Formation
Over-production of epinephrine
and norepinephrine from the
adenoma(s)
Detectable metanephrines
(epinephrine/norepinephrine
breakdown products) in both
plasma and urine
PATHOPHYSIOLOGY
Precipitating factor:
• Sporadic Mutation (DNA
damage arising from
exposure to mutagens)
Detectable mutations in
VHL, RET, SDH, and other
similar genes
Note: these tumors can be
fatal. Screening is essential in
patients with adrenal masses
Visible Adrenal Mass of
CT Scan (>3 cm)
Episodic hyper-activity of
the sympathetic nervous
system
Heart attack, stroke,
or death
Hyper-stimulation of G
protein-coupled receptors
involved in metabolic
processes
Legend:
Sign/symptom/lab finding
Abbreviations:
• MEN2 – Multiple Endocrine Neoplasm 2 syndrome
Pathophysiology
• NF1 – Neurofibromatosis 1
• RET – Rearranged during transcription
• SDH – Succinate Dehydrogenase Mechanism
• VHL- Von Hippel Lindau Syndrome
Complications
Blood pressure results in headache
the activation of neural
pain receptors
Tachycardia (increased Heart
Rate), Palpitations
Hyper-stimulation of
adrenergic receptors of Sustained or paroxysmal
the cardiac myocytes hypertension (increased Blood
Pressure)
Vasoconstriction of
Pallor
peripheral blood vessels
Panic, tremor, anxiety
Secretion from the Diaphoresis (excessive
eccrine sweat glands sweating)
Hyperglycemia
Ability to mobilize glucose
into the bloodstream
through enhanced lipolysis, Weight loss, fatigue
glycogenolysis and
gluconeogenesis
PHEOCHROMOCYTOMA | 2
CLINICAL MANIFESTATION • Risk for altered systemic tissue perfusion related to fluctuation in CV
We have this mnemonic “FIGHT & FLIGHT” status
- Facial flushing (from hypotension), fluttering in chest (palpitations) • Anxiety related to increased circulating catecholamines
- Increased BP and HR • Altered nutrition related to increased metabolic rate
- Glucose high • Risk for altered health maintenance related to insufficient knowledge of
- Headache (sudden and severe) follow up care.
- Tremors
- Frequent sweating (from hypotension) NURSING INTERVENTION:
- Loss of Weight
- Increased anxiety and fear • PRIORITY NURSING INTERVENTIONS
- Growing tumor can cause back or abdominal pressure or pain - AVOID OVER STIMULATION
- Heat intolerance
- Tired and weak (from constant stimulation) • STABILIZE PATIENT
- Provide bedrest
DIAGOSTIC TESTS
- Provide a calm and cool environment
• 24-HR Urine sample
- Administer pharmacologic treatment as prescribed/ordered
• Plasma levels of Catecholamines
• PATIENT TEACHING
• Glucose test
- Treatment
• Adrenal Biopsy
- Self-care
• Abdominal CT scan
- High calorie diet
• MRI of Abdomen
- Avoid stimulant substances
• Ultrasonography
- Follow-up visits
• clonidine suppression test
• MONITOR FOR
MEDICAL MANAGEMENT - ECG changes
- Hypertensive Crisis
PHARMACOLOGIC THERAPY: - Fluid and electrolyte balance
• Phentolamine (Regitine) - alpha-adrenergic blocking agent - Glucose levels
• Nitroprusside (Nitropress) - smooth muscle relaxants
• Phenoxybenzamine (Dibenzyline) - long-acting alpha-blocker FOR SURGERY:
• Nifedipine (Procardia) - Calcium channel blockers Pre-op
• Propranolol (Inderal) - Beta-adrenergic blocking agent • Stimulant free diet
• Metyrosine (Demser) - catecholamine synthesis inhibitors • Bedrest
• Administer Alpha adrenergic blocker as prescribed
SURGICAL MANAGEMENT: Post op
• Adrenalectomy (Bilateral may be necessary
NURSING MANAGEMENT • Monitor for hypovolemic shock caused by rapid relaxation of
constricted blood vessels
NURSING DIAGNOSIS: • Monitor for transient hypertensive episodes

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