Pheochromocytoma: Difference between revisions
ClaireLewis (talk | contribs) |
|||
| Line 24: | Line 24: | ||
==Management== | ==Management== | ||
*Hypertensive crisis: | *Hypertensive crisis: | ||
** α blockade with phenoxybenzamine or phentolamine acutely<ref>WJ Elliott, J Varon. Drugs used for the treatment of hypertensive emergencies. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 11, 2016.)</ref> | **[[alpha blockers|α blockade]] with phenoxybenzamine or [[phentolamine]] acutely<ref>WJ Elliott, J Varon. Drugs used for the treatment of hypertensive emergencies. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 11, 2016.)</ref> | ||
** | ***[[Phentolamine]]: 5mg IM/IV q2-4h PRN | ||
** | **[[Nitroprusside]] | ||
*Beta blockade can be started 2 days later | **[[Nicardipine]] | ||
*[[beta blockers|Beta blockade]] can be started 2 days later | |||
*Eventual surgical resection of tumor | *Eventual surgical resection of tumor | ||
Revision as of 16:50, 28 September 2019
Background
- Rare tumor arising from chromaffin cells in adrenal medulla or other paraganglia in the body
- Increased catecholamine production leading to its clinical manifestations
Clinical Features
- Headache
- Alternating periods of normal and elevated blood pressure, and can cause resistant hypertension and hypertensive emergency
- Tachycardia
- Flushed skin
- Palpitations
- Diaphoresis
- Weight loss
- Episodic anxiety
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Evaluation
- Plasma free metanephrines
- Urinary fractionated metanephrines
- CT imaging to localize tumor
- General lab features include hyperglycemia, hypercalcemia, and erythrocytosis
Management
- Hypertensive crisis:
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Phentolamine: 5mg IM/IV q2-4h PRN
- Nitroprusside
- Nicardipine
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Beta blockade can be started 2 days later
- Eventual surgical resection of tumor
Disposition
- Admission to a monitored setting
See Also
External Links
References
- ↑ WJ Elliott, J Varon. Drugs used for the treatment of hypertensive emergencies. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 11, 2016.)