Patient is unable to tolerate physical or emotional

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