Pheochromocytoma Lecture Notes

Overview

• Lecturer: Sarah Thread Sterner
• Series: NCLEX review on the Endocrine System
• Focus: Pheochromocytoma
• Areas Covered: Pathophysiology, signs and symptoms, nursing interventions, diagnosis

What is Pheochromocytoma?

• Tumor on the adrenal medulla
• Secretes excessive catecholamines (epinephrine, norepinephrine, dopamine)
• Usually benign, can occur in other areas (e.g., heart, head) as paraganglioma

Pathophysiology

• Adrenal Glands: Two glands located on top of kidneys
  • Adrenal Cortex: Outer layer
  • Adrenal Medulla: Middle layer containing chromaffin cells
• Chromaffin Cells: Secrete catecholamines in response to sympathetic nervous system
• Sympathetic Nervous System: Triggers fight-or-flight response

Role of Catecholamines

• Normally increase heart rate, blood pressure, glucose, fatty acid metabolism, and basal metabolic rate
• Pheochromocytoma causes unnecessary release, leading to physical symptoms without stress triggers

Signs and Symptoms (Mnemonic: "Fight and Flight")

• F: Facial flushing (due to hypertension)
• F: Fluttering in chest (palpitations)
• I: Increased heart rate and blood pressure
• G: Glucose level high (hyperglycemia)
• H: Headaches (sudden and severe)
• T: Tremors
• F: Frequent sweating
• L: Loss of weight
• I: Increased anxiety and fear
• G: Growing tumor pressure
• H: Heat intolerance
• T: Tiredness

Triggers

• Foods with tyramine (aged cheeses, wine, chocolates)
• Physical/emotional stress, surgeries, medications (MAO inhibitors)

Diagnosis

• 24-hour Urine Test: Checks for elevated catecholamines and metanephrins
• Imaging: MRI or CT scan to locate tumors
• Blood Test: Measures metanephrins

Treatment

• Adrenalectomy: Removal of adrenal gland(s)
  • Bilateral or unilateral based on tumor location
• Pre-op Medication: Alpha-adrenergic blockers to manage blood pressure

Nursing Interventions

• Monitor vital signs (heart rate, blood pressure)
• Prevent hypertensive crisis (systolic >180, diastolic >120)
• Watch for myocardial infarction or stroke signs
• Maintain calm, cool environment
• Provide high-calorie diet
• Educate on avoiding caffeine, vasoconstrictors, smoking
• Post-op hormone replacement therapy if adrenal glands are removed
• Medications:
  • Alpha Blockers: Decrease blood pressure, watch for reflex tachycardia
  • Beta Blockers: Manage tachycardia and lower blood pressure

Additional Resources

• Quiz available on the instructor’s website
• Series includes other endocrine system lectures

Conclusion

• Understanding pheochromocytoma is crucial for NCLEX and nursing practice
• Further learning and testing through available quizzes and resources