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62 - Pheochromocytoma

from Section 10 - Endocrine emergencies

Published online by Cambridge University Press:  05 November 2013

By
Jolene H. Nakao
Edited by
Kaushal Shah ,
Jarone Lee ,
Kamal Medlej  and
Scott D. Weingart
Kaushal Shah
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
Jarone Lee
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston
Kamal Medlej
Affiliation:
American University of Beirut
Scott D. Weingart
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
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Summary

This chapter discusses the diagnosis, evaluation and management of pheochromocytoma. Pheochromocytoma can present as a hypertensive crisis. This may be triggered by physiological stress including recent surgery, trauma, or pregnancy; tumor manipulation; anesthetic agents at the induction of anesthesia; or drugs including corticosteroids, antiemetics such as metoclopramide, and imipramine. Management of emergencies in patients with pheochromocytoma depends on symptoms. It should always include pharmacological treatment to block the effects of high levels of circulating catecholamines and prevent complications. Hypertensive crisis due to pheochromocytoma should be treated with repeated doses of phentolamine, a continuous infusion of phentolamine, or a continuous infusion of sodium nitroprusside. Definitive treatment for pheochromocytoma is surgery. Emergency surgical removal of the tumor is indicated if the patient deteriorates despite aggressive medical treatment appropriate for pheochromocytoma, even if the patient is critically ill, to increase chances of survival.

Keywords

pulmonary edemanoninvasive positive-pressure ventilationvasopressorshypotensionacute kidney injurycardiac arrhythmiashyperkalemia
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 408 - 412
Publisher: Cambridge University Press
Print publication year: 2013

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