Pheochromocytoma: Difference between revisions
(Add MedicationDose SMW entry for phentolamine; dose verified against endocrine emergency guidelines) |
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**If beta blockade started before alpha blockers, unopposed alpha activity can precipitate [[hypertensive emergency]] | **If beta blockade started before alpha blockers, unopposed alpha activity can precipitate [[hypertensive emergency]] | ||
*Eventual surgical resection of tumor | *Eventual surgical resection of tumor | ||
==Medication Dosing== | |||
*{{MedicationDose|drug=Phentolamine|dose=5 mg q2-4hr PRN|route=IV/IM|context=Alpha-blocker for hypertensive crisis|indication=Pheochromocytoma|population=Adult|notes=Must achieve alpha blockade before beta blockade}} | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 18:01, 20 March 2026
Background
- Rare tumor arising from chromaffin cells in adrenal medulla or other paraganglia in the body
- Increased catecholamine production leading to its clinical manifestations
Clinical Features
- Paroxysms usually lasting <1 hour of the following symptoms:
- Headache
- Tremor
- Alternating periods of normal and elevated blood pressure, and can cause resistant hypertension and hypertensive emergency
- Tachycardia
- Flushed skin
- Palpitations
- Diaphoresis
- Anxiety
- Weight loss
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Evaluation
- Plasma free metanephrines
- Urinary fractionated metanephrines
- Plasma and urine catecholamines
- CT with adrenal protocol imaging to localize tumor
- PET scan may eventually be required
- General lab features include hyperglycemia, hypercalcemia, and erythrocytosis
Management
- Hypertensive crisis:
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Phentolamine: 5mg IM/IV q2-4h PRN
- Nitroprusside
- Nicardipine
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Beta blockade can be started 2 days later
- If beta blockade started before alpha blockers, unopposed alpha activity can precipitate hypertensive emergency
- Eventual surgical resection of tumor
Medication Dosing
- Phentolamine 5 mg q2-4hr PRN IV/IM — Must achieve alpha blockade before beta blockade
Disposition
- Admission to a monitored setting
See Also
External Links
References
- ↑ WJ Elliott, J Varon. Drugs used for the treatment of hypertensive emergencies. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 11, 2016.)