Pheochromocytoma

„ Rare neuroendocrine
PHEOCHROMOCYTOMA tumor of the medulla of the
adrenal glands (originating
in the chromaffin cells), or
extra-adrenal chromaffin
tissue that secretes
excessive amounts of
By: catecholomines
Belkys Cota, Priscilla Carpio, (epinephrine and
Melissa Houchin, Leslie N. Beltran. norepinephrine) --
hormones that regulate
heart rate and blood
pressure.

Pheochromocytoma Extra-Adrenal Sites

„ Within the sympathetic nerve
„ May occur as a single
chain along the spinal cord
tumor or as more than (orange spots)
one growth. „ Overlying the distal aorta (the
„ It usually develops in main artery from the heart)
the center (medulla) of (green spots)
one or both adrenal „ Within the ureter (collecting
system from the kidney
glands. (yellow spot)
„ Sometimes this kind of „ Within the urinary bladder
tumor occurs outside (blue spot)
the adrenal gland. „ Remember, 90% are in the
adrenal glands (red spots
on the kidneys)

Factors associated with

Signs and Symptoms
pheochromocytoma include:
„ Hyperglycemia
„ A family history of pheochromocytoma
„ Tachycardia
„ Tumors in other glands of the body „ Anxiety
„ Other hormonal disorders „ Chest pain
„ Palpitations
„ Genetic diseases including:
„ Severe headache
„ Von Hippel-Lindau disease „ Flushing
„ Multiple endocrine neoplasia, type 2 „ Diaphoresis
„ Neurofibromatosis type 1 „ Abdominal pain
„ Paraganglioma syndromes „ Increased appetite
„ Weight loss
 Exams and Tests: Treatment
Pharmacologic Therapy Surgical Management
Decrease BP: •Adrenalectomy
„ 24 hr Urine Sample •Alpha-adrenergic blocking agents.- •Nipride
eg. Phentolamine (Regitine) •IV Corticosteroid replacement:
„ Plasma levels of Laboratory analysis will •Smooth muscle relaxants.- Solu-Medrol
Catecholamines reveal increased urine eg. Na nitroprusside (Nipride) •Oral Corticosteroids:
Before and During Surgery: Prednisone
„ Glucose test catecholamines, • Long-acting alphablocker.-
„ Adrenal biopsy vanillylmandelic acid Phenoxybenzamine (Dibenzyline)
„ Abdominal CT scan (VMA) and • Ca Channel Blockers.-
metanephrine. Nifedipine (Procardia)
„ MRI of abdomen •Beta-adrenergic blocking agents.-
„ ultrasonography Propranolol (Inderal)
•Cathecholamine synths. inhibitors.-
Methyrosine

Prognosis Assessment Findings

•1/3 Patients continue to be hypertensive:
1)Not all tissue removed
2)Recurrence
3)Blood vessels damaged by severe & prolonged
hypertension
•The tumors come back in less than 10% of these
patients.
• Release of the hormones norepinephrine and
epinephrine returns to normal after surgery.
•Less than 50% of patients who have cancerous
tumors that spread to the bones, liver, or lung are
alive after 5 years.
„ hypertension (may be persistent, fluctuating,
intermittent, or paroxysmal)
„ pounding headaches
„ hyperglycemia and glucosuria
„ tachycardia, apprehension, palpitations
„ profuse sweating, cold extremities
„ nausea, vomiting
„ dilated pupils

Nursing Assessment: Nursing assessment cont…

„ Blood sugar
„ The “Five Hs” Presence of these signs
has a 93.8% specificity - Hypoglycemia (after surgery)
- Hypertension
& 90.9% sensitivity for - Hyperglycemia (before and during surgery)
- Headache pheochromocytoma.
„ Blood pressure
- Hyperhidrosis
- Hypertension (before and during surgery)
- Hypermetabolism
- Hypotension (after surgery)
- Hyperglycemia
Nursing assessment cont… Nursing Dx:
„ Other vital signs „ Risk for injury related to potential for
„ hemodynamic parameters
hypertensive crisis.
„ fluid and electrolyte status—including intake
Patient Outcomes:
and urinary output—and urine catecholamine „ Identify early sign and symptoms of
levels. hypertensive crisis, and seek medical
„ Assess the patient for bleeding and infection treatment immediately if they develop
„ Assess the patient for pain „ Avoid factor known to precipitated
hypertensive crisis
„ Remain free for injury

Nursing Dx: Nursing Dx:

„ Anxiety related to potential seriousness and „ Ineffective renal tissue perfusion related to
associated complications of adverse effects of hypertension in renal
pheochromocytoma. vascular system.

Patient Outcomes: Patient Outcomes:

„ Identify and express her/his feelings about „ Maintain adequate renal function
the diagnosis „ Have normal renal function studies
„ Perform activities that help lower anxiety
„ Demonstrate positive coping method

Planning & Implementation Evaluation:

„ Stabilize patient : „ BP stable
1) Prescribed Bedrest „ Hyperglycemia controlled
2) Pharmacologic Treatment
„ Patient reports pain relief and improves
„ Patient teaching:
comfort
Treatment
„ Lungs are clear to auscultation
Prognosis
„ Prepare patient for treatment „ No signs of resp. problems
„ Monitor: ECG changes, arterial pressures, fluid and „ There is no evidence of infection
electrolyte balance, and blood glucose levels. „ Follow- Up
„ Patient teaching: Self-Care, Follow-up visits.
 Question #1

„ 90% of all pheochromocytomas are found?

a) Within the sympathetic nerve chain along the

spinal cord
b) In the medulla of the adrenal glands
c) Within the urinary bladder
d) All of the above

Question #2 Question #3
„ Pheochromocytoma disturbs the secretion of „ Which is the most common symptom related
which hormones? to pheochromocytoma?

1) TSH 1) Pyuresis
2) FSH 2) Nausea & Vomiting
3) Epinephrine & Norepinephrine 3) Anxiety
4) ACTH 4) Hypertension

Question #4 Question #5
„ What is the most conclusive test for the „ What is the primary treatment for this tumor?
diagnosis of pheochromocytoma?
1) Adrenalectomy
1) CT scan 2) Chemotherapy
2) MRI 3) Insulin Therapy
3) 24 hr Urine Sample 4) Radiation
4) Ultrasonography
 References
Clayton L. Thomas, MD, MPH. Taber’s Cyclopedic Medical Dictionary, Edition 16
Illustrated. F.A. Davis Company, Philadelphia, 2005.

Dalal, T., Maher, M. (2005) Extraadrenal Pheochromocytoma: A Rare Cause of

Tachycardia and Hypertension During Percutaneous Biopsy . Massachusetts General
Hospital and Harvard Medical School Boston, MA 02114.
http://www.ajronline.org/cgi/content/full/185/2/554?ck=nck

Gavaghan, M. (1997) Surgical treatment of pheochromocytomas AORNJournal.

http://findarticles.com/p/articles/mi_m0FSL/is_
n6_v65/ai_19532261

Pheochromocytoma Prognosis. Retrieved March 6, 2008, from eMedTV (2008):

http://cancer.emedtv.com/pheochromocytoma/pheochromocytoma-prognosis.html

Pheochromocytoma. Retrieved March 6, 2008, from Wikipedia (2008):

http://en.wikipedia.org/wiki/Pheochromocytoma

Smeltzer, S.C., Bare, G.B., Hinkle, J.L. (2008). Brunner & Suddarth’s: Textbook of
Medical-Surgical Nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.