Master Pheochromocytoma with Picmonic for Physician Assistant

Pheochromocytoma is caused by a tumor in the adrenal medulla that affects the chromaffin cells. As a result, an excess of catecholamines are produced and may cause severe effects such as hypertension.

The affected chromaffin cells cause increased catecholamine production. Catecholamines include epinephrine and norepinephrine. An increase in catecholamine production leads to severe hypertension, tachycardia, and profuse sweating.

Severe episodic hypertension is a defining characteristic of pheochromocytoma. Untreated pheochromocytoma may progress to hypertensive encephalopathy, diabetes, cardiomyopathy, and death. Classic manifestations related to pheochromocytoma include pounding headache, tachycardia, palpitations, and profuse sweating. Monitoring the patient's blood pressure is critical for early detection and intervention of severe hypertension.

Profuse sweating, or diaphoresis, is caused by increased catecholamine production related to an adrenal medulla tumor. In addition to a severe pounding headache and tachycardia, diaphoresis is a part of the classic triad of symptoms associated with pheochromocytoma.

Patients with pheochromocytoma may experience unexplained abdominal or chest pain. Attacks may be caused by medications such as tricyclic antidepressants, antihypertensives, opioids, and radiologic contrast media.

Surgical removal of the adrenal tumor is the primary treatment of pheochromocytoma. Laparoscopy is the most common approach to removing the tumor. Although removal of the adrenal tumor usually alleviates hypertension, a small percentage of patients still experience hypertension despite surgery.

Beta-adrenergic blockers such as propranolol are administered after adequate alpha-adrenergic blockade. Since unopposed alpha-adrenergic stimulation may cause hypertensive crisis, it is important to administer beta-blockers after sufficient alpha-adrenergic blockade. Beta-blockers are indicated to decrease tachycardia and other dysrhythmias. Additionally, calcium channel blockers like nicardipine may also be used as antihypertensive. Since the medications may cause orthostatic hypotension, instruct the patient to change positions slowly with caution.

Alpha-adrenergic blockers such as phenoxybenzamine (Dibenzyline) are indicated to treat patients with pheochromocytoma. The medication is administered 7-10 days preoperatively to decrease the patient's blood pressure and alleviate symptoms caused by excessive catecholamines.

The administration of metyrosine (Demser) is indicated for patients with pheochromocytoma who are not appropriate candidates for surgery. The medication is used to decrease the tumor's catecholamine production.

Avoid abdominal palpation in patients suspected with pheochromocytoma. Palpating the abdomen with pheochromocytoma may cause a sudden release of catecholamines resulting in severe hypertension.