Key takeaway
Hallmark finding is severe, often paroxysmal hypertension, sometimes with markedly elevated blood pressure.
What is pheochromocytoma?
The hormone surges produce dramatic, paroxysmal symptoms and dangerous blood pressure spikes. Memory aid: the classic triad is the '5 Ps' simplified to pounding headache, palpitations, and perspiration (diaphoresis) with severe hypertension. Definitive treatment is surgical removal of the tumor.
Key points to remember
- Hallmark finding is severe, often paroxysmal hypertension, sometimes with markedly elevated blood pressure.
- Classic triad is pounding headache, palpitations/tachycardia, and profuse diaphoresis.
- Other features include anxiety, tremor, flushing, pallor, and hyperglycemia.
- Catecholamine surges can be triggered by stress, exertion, or palpation of the abdomen.
- Diagnosis is supported by elevated urine and plasma catecholamines and metanephrines (24-hour urine for VMA/metanephrines).
Signs & symptoms
- 5 H's: HTN, headache, hyperhidrosis
- Palpitations, paroxysmal BP spikes
- Tremor, pallor, anxiety
Nursing priorities
- Monitor blood pressure frequently and avoid palpating the abdomen, which can trigger a catecholamine surge.
- Provide a calm, restful environment and minimize stress and stimulation.
- Administer alpha-adrenergic blockers first as ordered, then beta blockers, to control blood pressure preoperatively.
- Prepare the patient for adrenalectomy and monitor for hemodynamic instability before, during, and after surgery.
- Monitor blood glucose and provide adequate hydration.
Labs & values
24-hour urine metanephrines/VMA: elevated24-hour urine metanephrines/VMA: elevated
Plasma free metanephrines: elevated
Glucose: may be elevated (normal fasting70-100 mg/dL)
Patient teaching
- Avoid activities and foods that trigger episodes, and report severe headache, sweating, or palpitations.
- Take prescribed blood pressure medications exactly as directed before surgery.
- After adrenalectomy, attend follow-up to monitor blood pressure and hormone levels.
Red flags: report now
- A hypertensive crisis with severe headache, chest pain, or neurologic changes is a life-threatening emergency.
- Never palpate the abdomen, as it can trigger a sudden, dangerous catecholamine release.
- Report severe blood pressure swings or signs of stroke or myocardial infarction immediately.
References
Clinical references for this topic
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