Patient is unable to tolerate physical or emotional stress without additional exogenous corticosteroids o long-term care revolves around recognizing the need for extra medication and techniques for stress management Teach patient importance of maintaining daily corticosteroid replacement therapy Teach patient to appropriately increase dosing during stress Teach patient signs and symptoms of corticosteroid deficiency and excess Medic alert bracelet Home BP monitoring Emergency IM hydrocortisone kit Pheochromocytoma
Rare condition caused by tumor of the adrenal medulla Causes excess release of catecholamines (epinephrine, norepinephrine)-hormones that control HR, BP, metabolism o The most dangerous immediate effect of the disease is severe hypertension Occurs in both genders and at any age (most common in young to middle age adults) Tumors usually benign, encapsulated, unilateral BL tumors rarely occur If untreated may lead to DM, cardiomyopathy and death What does excess epi/norepi cause? HTN! Pheochromocytoma Severe episodic hypertension associated with: o Severe pounding headache o Tachycardia o Palpitations o Diaphoresis o Chest/abdominal pain o Anxiety o Triad – severe headache, tachycardia, profuse sweating Often provoked by medications: o Antihypertensions o Opiods o Radiologic contrast dye o TCA’s – tricyclic antidepressant Pheochromocytoma Secondary cause of HTN (only 0.1% of all cases of HTN) Often missed Consider for patients who do not respond to traditional antihypertensives Measurement of urinary fractionated metanephrines (Catecholamine metabolites) via 24 hour urine Values are elevated in 95% of persons with pheochromocytoma CT/MRI to diagnose tumors DO NOT press on abd of pt with pheochromocytoma bc it could trigger release of catecholamines and severe hypertension Pheochromocytoma Surgery o Open vs. Laparoscopic o Nursing care same as discussed for adrenalectomy Pre-op
o Manage BP via: Alpha adrenergic blockers Beta adrenergic blockers The α-adrenergic receptor blocker phenoxybenzamine (Dibenzyline) is given 7 to 10 days preoperatively to reduce BP and alleviate other symptoms of catecholamine excess Monitor blood glucose- long term exposure to epi and norepi can cause an increased risk of DM Avoid smoking, caffeine Do not palpate abdomen Pheochromocytoma HTN usually resolves with tumor removal HTN may persist after removal (10-30%) o Treat with routine antihypertensive meds Metyrosine o Pharmacological treatment if nonsurgical candidate o Decreases catecholamine production by tumor o Can cause orthostatic hypotension Stand slowly, hold onto secure object
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- Spring '10
- Cortisol, Adrenal cortex, ACTH stimulation test, Cushing Syndrome, Primary Adrenal Insufficiency, Urine cortisol levels