Compiled By: Mr. Ashish Roy

1. PHEOCHROMOCYTOMA
(PCC)
COMPILED BY –
Mr Ashish H. Roy
(Nursing Tutor)

2. DEFINITION
 Pheochromocytoma is a rare condition characterized by a
tumor arising from the chromaffin cells of the adrenal
medulla that produces excessive catecholamine
(epinephrine & nor- epinephrine)
OR
 A chromaffin cells of the adrenal medulla causing
increased secretion of epinephrine or non- epinephrine
resulting in hypertension. It is catechdamine secreting
neoplasm.

3. INCIDENCE
 It is not common. It can occur at any age, peak between
40 & 50 years.
 It can occur at any group age but is most common
between the age of 30 and 60. Most pheochromocytoma
tumors are benign, 10% are malignant with metastasis.
 Around 25% of patients have an inherited condition.

4. ETIOLOGICAL CAUSES/ RISK FACTORS
 Idiopathic (unknown)
 Heredity
 Thyroid carcinoma
 Parathyroid hyperplasia or tumour
 Hemangiomas of the retina, cerebellum, brain stem, spinal
cord
 Pancreatic cyst
 Renal cysts, adenomas
 Carcinoma

5. Pathophysiology

6. CLINICAL FEATURES/ SIGNS & SYMPTOMS
 5 ‘H’. Hypertension, Headache,
Hyperhydrosis, Hyper metabolism,
Hyperglycemia.
 Orthostatic hypotension
 Tachycardia
 Chest pain
 ECG changes
 Heat intolerance
 Sweating
 Fever
 Weight loss
 Nausea, vomiting
 Increased blood glucose level
 Vertigo,
 diarrhea, polyuria
 seizures
 Fatigue
 Abdominal pain
 constipation

7. Diagnostic Assessment
 History taking and physical assessment:- Pheochromocytoma is
suspected when the patient shows the signs characterized by 5
‘H’.Hypertension, headache, hyperhydrosis, hypermetabolism,
hyperglycemia.
 24hr urine test
 Increased Blood Plasma catecholamines ( normal epinephrine-
100pg/ml. nor epinephrine- 100-550pg/ml)
 Urinary catecholamine's metabolites increased VMA (vanillylmandelic
Acid), normal : 10-250mg/24hr.
 Glucagons stimulation test
 CT scan and Magnetic Resonance Imaging (MRI) of the adrenal glands
or of the entire abdomen are done to identify tumor.
 Clonidine suppression test is used to distinguish essential hypertension
from pheochromocytoma.
 Radionuclide studies localize the tumor

8. Medical Management
 Alpha- adrenergic blockers e.g.- phenoxybezamine
(10mg-20mg every 6-8hrs) or Prazosin (2-5 mg twice a day)
 Calcium channel blockers e.g.- nifedepine
 Beta blockers e.g.- Propanolol
 Saline & blood products if needed
 Alpha- Methyl- P- tyrosine if surgery is contra indicated
 Chemotherapy e.g.- 5 Fluorouracil

9. Surgical Management
 Adrenalectomy- unilateral or bilateral.
 Laparoscopic removal of the tumor
 Laparotomy Selective resection of the tumors, sparing the
adrenal cortex

10. NURSING DIAGNOSIS
 Pain related tumor AEB verbalization
 Ineffective breathing pattern Related dyspnea/ tachypnea AEB
respiratory rate.
 Activity intolerance Related dyspnea AEB inability to meet
ADL.
 Fluid volume deficit Related diarrhea/ polyuria AEB skin turgor.
 Ineffective therapeutic regimen Related lack of knowledge of
long term management aEB questions about disease.
 Anxiety related to symptoms from increase osteocholamines
headache, palpitation, sweating, nervousness.
 Risk For ineffective tissue perfusion related to hypotension
during postoperative period.

11. Pre- operative Management
 Check vital signs
 Assess the level of anxiety
 Provide supportive care
 Prepare the patient for tests and surgery
 Cardiac monitoring
 Limit activities like bending & lifting
 Maintain nutritional status with a high protein calorie diet with
adequate vitamins & minerals.
 Administer IV fluids, blood transfusion if needed.
 Hormonal therapy as prescribed
 Correct fluid & electrolyte imbalance.
 Nurse should discuss the patient activites that promote relaxation
and stress relaxation techniques
 Nurse will educate the patient about regarding life style changes
that help to decrease number of triggers

12. Post Operative Care
 Monitoring to detect complications of surgery and Adrenal crisis
 Blood pressure alteration Blood glucose alteration
 Fluid & electrolyte imbalance
 plan the activity & period of rest
 Assess effects of posture on blood pressure
Provide measures to minimize effects of postural hypotension(Orthostatic
hypotension - also called postural hypotension - is a form of low blood pressure
that happens when you stand up from sitting or lying down.)
 Assist the patient during ambulation while BP remains stable
 Provide measures to decrease the risk of infection in the immuno suppressed
patients.( strict surgical asepsis, coughing & deep breathing exercises, avoiding
contact with persons with URI)
 Administer IV fluids as prescribed
 Monitor serum electrolytes daily, blood glucose levels 4hrly, weight daily, hpurly
intake & output.
 Provide medications as prescribed by the surgeon.

13. Complications
 Hypertensive retinopathy
 Hypertensive nephropathy
 Myocarditis ( inflammatory cardiomyopathy)
 Increased platelet aggregation
 CHF,MI, Arrhythmias, Shock
 Renal failure
 Aortic aneurism
 Fluid and electrolyte imbalance

14. FAQ
WHAT ARE CHROMAFFIN CELLS ???
Chromaffin cells, also pheochromocytes, are neuroendocrine cells found
mostly in the medulla of the adrenal glands in mammals. These cells serve a
variety of functions such as serving as a response to stress, monitoring
carbon dioxide and oxygen concentrations in the body, maintenance of
respiration and the regulation of blood pressure. They are in close proximity
to pre-synaptic sympathetic ganglia of the sympathetic nervous system,
with which they communicate, and structurally they are similar to post-
synaptic sympathetic neurons. In order to activate chromaffin cells, the
splanchnic nerve of the sympathetic nervous system releases acetylcholine,
which then binds to nicotinic acetylcholine receptors on the adrenal
medulla. This causes the release of catecholamines. The chromaffin cells
release catecholamines: ~80% of adrenaline and ~20% of noradrenaline
into systemic circulation for systemic effects on multiple organs, and can
also send paracrine signals. Hence they are called neuroendocrine cells.

15. THANKYOU FOR YOUR ACTIVE
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The End.