PHEOCHROMOCYTOMA

KRISTIAN DAVE DIVA, SN

Pheochromocytoma
oDefinition: It is a tumor found on the
adrenal medulla of the kidneys that
secretes excessive amounts of
catecholamines.
 Pathophysiology of
Pheochromocytoma
 Key Players:
o Adrenal gland: the human body has two adrenal glands that are cone-
shaped that sit on the kidneys. The outer layer is the adrenal cortex and
the center layer is the adrenal medulla (tumors are found here).

o Adrenal Medulla: found in the adrenal gland and is within the adrenal
cortex. Its role is to secrete epinephrine (adrenaline), norepinephrine
(noradrenaline), and low amounts of dopamine in response to the
bodys sympathetic nervous system (fight or flight system) via
chromaffin cells.
o Chromaffin Cells: founds in the adrenal medulla and secrete
catecholamines. This is what the tumor is made up of (tumors tend to be
benign). These cells are also found in the heart, head, neck, bladder,
spine, abdomen. If a tumor(s) develops in this area it is known as
paragangliomas rather than pheochromocytoma
Catecholamines: have a huge influence on how organs and tissues work.
They cause the body to do the following:

o increase heart rate and blood pressure

o increase glucose (stimulates the liver to release it stores of glucose in the

blood and blocks the role of insulin)

o increases fat metabolism for energy (breaking down of fats for fuel)

o increases basal metabolic rate (burns more calories)

o increases thermogenesis (elevates body temperature)

o how you respond to danger (fear/anxiety.)

Signs & Symptoms of
Pheochromocytoma
oFacial flushing (from hypertension), fluttering in
chest (palpitations)

oIncreased blood pressure & heart rate

oGlucose high

oHeadaches (sudden and severe)

oTremors
o Frequent sweating (from hypertension)

o Loss of weight

o Increase anxiety and fear

o Growing tumor can cause back or abdominal pressure

or pain

o Heat intolerance

o Tired and weak (from the constant stimulation)

o ***Signs and symptoms can happen in episodes or
triggered after an event:

o Eating foods with Tyramine (plays a role in pressure

blood): foods that are aged, pickled, fermented like
cheeses, red wine, smoke/dried meat, bananas,
sauerkraut, chocolate.

o Surgery, trauma injury, emotional stress, medications

such as Monoamine Oxidase Inhibitors: MAOIs
 Diagnostic Test for
Pheochromocytoma
o 24-hour urine for catecholamines and metanephrines (are
metabolites formed when the body breaks down
catecholamines).if too many metabolites are found
then there are too many catecholamines being
produced). If this test comes back positive the doctor
may order a MRI or CT scan of the adrenal glands to
inspect for tumors.

o Blood test to measure metaneprhines.

 Treatment for
Pheochromocytoma
Adrenalectomy: remove the adrenal gland with the tumor
(may remove one or both depending on where tumor is
located)
Nursing Interventions for
Pheochromocytoma
o Monitor vital signs: blood pressure, heart rate

o Monitor for hypertensive crisis: >180 systolic or >120

diastolicif blood pressure is too high for a long period
of time this can cause damage to vital organskidneys,
eyes, brain, heart.

o Signs and symptoms of this: headache, vision

changes, neuro changes, seizures, shortness of breath
o Monitor for chest pain (risk for MI), neuro status (stroke),
EKG changes, hyperglycemia

o Provide a calm and cool environment.no

overstimulation!

o Per MD order: Administer pre-opt (prior to

adrenalectomy) alpha-adrenergic blockers
Education for patient with
pheochromocytoma:
o Avoid stimulant substances: energy drinks, caffeine
products, or smoking (due to vasoconstriction)

o For patient going for an adrenalectomy: educate about

having to take hormone replacement medications after
surgery and taking alpha-adrenergic prior to surgery
(usually 2 weeks before surgery)
o If patient is having a bilateral adrenalectomy (both
glands removed ): will have to take glucocorticoids
and mineralocorticoid for life.

o If patient is having a unilateral adrenalectomy (only

one gland removed): will have to take glucocorticoids
for approximately 2 years.
 TO TEST YOUR
UNDERSTANDING!
o Pheochromocytoma disturbs the secretion of which
hormones?

A. 1) TSH

B. 2) FSH

C. 3) Epinephrine & Norepinephrine

D. 4) ACTH
o Which is the most common symptom related to
pheochromocytoma?

a) Pyuresis

b) Nausea & Vomiting

c) Anxiety

d) Hypertension
o What is the most conclusive test for the diagnosis of
pheochromocytoma?

a) CT scan

b) MRI

c) 24 hr Urine Sample

d) Ultrasonography
o What is the primary treatment for this tumor?

a) Adrenalectomy

b) Chemotherapy

c) Insulin Therapy

d) Radiation