Pheochromocytoma Flashcards
Testing for pheo:
Urine metanephrines (products of epi), VMA (metabolite of epinephrine)
What can you see on EKG in people with pheo?
ST-T changes
Hyperglycemia in these patients?
Yes-reflects beta effects of catecholamines and typically does NOT require insulin
Triggers for pheo:
anger, fear, anxiety
direct and indirect sympatho
histamine releasing agents
Pre op what do yo want:
When are the pts ready?
see tumor with imaging
ALPHA block first-THEN beta
Ready after 10-14 days of pre tx nd no BP aboe 160/90 for 24 hours, no orthostatic hypotension
no st-t abnomalities
Are you placing a line in these pheo pts?
YES. also consider pre op volume loading since they are usually depleted.
Intraop pheo
Be ready with shourt acting hypotensive agents like esmolol
BP may get super high with ;manipulation of tumor
BP can fall precipitously once blood supply to tumor is ligated. If hypotensio occurs, it should still be treated with volume and IV norepi.
Rule out surgical bleeding as a cause of hypotension.
Post op with pheo:
Hypoglycemia can occur
Perioperative glucose testing is mandatory
ICU fterwards!!!
If pt still significantly hypotensive-might not have been all the way removed
