PHEOCHROMOCYTOMA.pptx

pheochomocytom

1. PHEOCHROMOCYTOMA Mrs.Usha Rani Kandula , Assistant professor, Department of nursing, Arsi University, Asella , Ethiopia.

2. PHEOCHROMOCYTOMA Pheochromocytoma is a tumor that is usually benign and originates from the chromaffin cells of the adrenal medulla . In 80% to 90% of patients, the tumor arises in the medulla ; in the remaining patients, it occurs in the extra-adrenal chromaffin tissue located in or near the aorta, ovaries, spleen, or other organs . Pheochromocytoma may occur at any age, but its peak incidence is between ages 40 and 50 years

3. Pheochromocytoma is the cause of high blood pressure in 0.2 % of patients with new onset of hypertension. Pheochromocytoma may occur in the familial form as part of multiple endocrine neoplasia type 2 ;

4. Clinical Manifestations The nature and severity of symptoms of functioning tumors of the adrenal medulla depend on the relative proportions of epinephrine and norepinephrine secretion . The typical triad of symptoms comprises headache, diaphoresis, and palpitations. Hypertension and other cardiovascular disturbances are common . Other symptoms may include tremor, headache , flushing, and anxiety.

5. Hyperglycemia may result from conversion of liver and muscle glycogen to glucose by epinephrine secretion ; insulin may be required to maintain normal blood glucose levels . The clinical picture in the paroxysmal form of pheochromocytoma is usually characterized by acute, unpredictable attacks lasting seconds or several hours. During these attacks, the patient is extremely anxious, tremulous, and weak. The patient may experience headache, vertigo, blurring of vision, tinnitus, air hunger , and dyspnea.

6. Other symptoms include polyuria, nausea, vomiting , diarrhea, abdominal pain, and a feeling of impending doom . Palpitations and tachycardia are common. Blood pressures exceeding 250/150 mm Hg have been recorded.

7. Such blood pressure elevations are life-threatening and may cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute renal failure. Postural hypotension occurs in 70% of patients with untreated pheochromocytoma .

8. Assessment and Diagnostic Findings Pheochromocytoma is suspected if signs of sympathetic nervous system overactivity occur in association with marked elevation of blood pressure. These signs can be associated with the “five Hs ”: hypertension , headache, hyperhidrosis (excessive sweating ), hypermetabolism , and hyperglycemia.

9. Factors that may elevate catecholamine levels must be controlled to obtain valid results; these factors include consumption of coffee or tea, use of tobacco, emotional and physical stress, and use of many prescription and over-the-counter medications ( eg , amphetamines, nose drops or sprays, decongestant agents, and bronchodilators ).

10. Imaging studies, such as CT scans, MRI, and ultrasound, may also be carried out to localize the pheochromocytoma and to determine whether more than one tumor is present . I- metaiodobenzylguanidine (MIBG) scintigraphy may be required to determine the location of the pheochromocytoma and to detect metastatic sites outside the adrenal gland.

11. SURGICAL MANAGEMENT The definitive treatment of pheochromocytoma is surgical removal of the tumor, usually with adrenalectomy . Bilateral adrenalectomy may be necessary if tumors are present in both adrenal glands . Administration of antihypertensive medications Intravenous fluid administration Corticosteroid replacement is required if bilateral adrenalectomy has been necessary . Thanking you.