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Pheochromocytoma
A rare but serious disease resulting from excess catecholamine release characterized by paroxysmal or sustained hypertension, almost always due to a tumor of the adrenal medulla
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Pheochromocytoma - s/s
- Hypertension
- Diaphoresis
- Hyperglycemia
- Severe headaches
- Palpitation, profuse sweating
- Tremor
- Tachycardia
- Weight loss
- Postural hypotension
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Pheochromocytoma - laboratory diagnostics
- TSH is normal
- May be hyperglycemic or glycosuric
- Plasma-free metanephrines:
- - plasma concentration of normetanephrines>2.5, or
- metaneprhine levels >1.4
- Assay of urine catecholamines, metanephrines, vanillylmandelic acid and creatinine. 24 hour urine ?2.2 metanephrine per mg creatinine and >5.5 mg VMA per mg creatininte
- CT and MRI of adrenals used to confirm or localize tumor
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Pheocromocytoma management
- 1. Surgical removal of tumor is treatment of choice
- 2. Alpha adrenergic medication preoperatively may be used
- - Phentolamine (Regitine)
- - as soon as possible, convert to PO phenoxybenzamine
- 3. Postoperatively, watch for:
- - Hypotension (depleted catecholamines)
- -adrenal insufficiency
- -Hemorrhage
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