Med-Surg Endocrine System, part 13: Pheochromocytoma & Hyperaldosteronism

by Cathy Parkes August 01, 2020

Full Transcript

Alright. In this video, we are going to talk about pheochromocytoma and hyperaldosteronism. Let's first talk about pheochromocytoma, which is where we have a tumor on the adrenal gland, which causes excess secretion of norepinephrine and epinephrine, which are catecholamines from the adrenal medulla, which is like the inside part of the adrenal gland. So with this excess secretion of epinephrine and norepinephrine, that activates the body's sympathetic response, and basically, throws the body into fight or flight mode. So signs and symptoms of this condition include tachycardia, hypertension, headache, diaphoresis, and shortness of breath. In terms of diagnosis, we can do a 24-hour urine test where we test for byproducts from the breakdown of epinephrine and norepinephrine. So some of these byproducts include vanillylmandelic acid as well as metanephrine. So if we find that we have elevated levels of these substances over a 24-hour period in the urine then that would be indicative of pheochromocytoma. The other test we can do is a clonidine suppression test. So clonidine is a medication we give for high blood pressure. It acts on the central nervous system and should decrease the sympathetic outflow and with decreased sympathetic nervous system outflow, we should have decreased secretion of epinephrine and norepinephrine. However, if we have continued high levels of epinephrine and norepinephrine being released from the adrenal gland regardless of central nervous system function, then that is also strongly indicative that we may have a tumor and pheochromocytoma present. And then lastly, we can, of course, do a CT, MRI of the adrenal gland to help identify that tumor.

So in terms of treatment, the patient's going to need surgery. We need to remove that tumor and they may need an adrenalectomy. And then prior to surgery, we definitely want to be giving the patient antihypertensive medications because of that extreme hypertension that's related to this disorder. One important thing for you to remember as a nurse is you never want to palpate the abdomen of a patient who is suspected of having pheochromocytoma because that can trigger the sudden release of catecholamines, which, in turn, can trigger severe hypertension in the patient, which can be very dangerous.

Alright. Now let's talk about hyperaldosteronism. This is where we have an adenoma or hyperplasia in the adrenal gland such that excess amounts of aldosterone are being secreted. And if you recall, aldosterone is a hormone that causes reabsorption of sodium and water and excretion of potassium. So if we have too much aldosterone, that's going to cause excess reabsorption of sodium and water and excess excretion of potassium. So in terms of signs and symptoms, hypertension is going to be a key symptom, and it makes sense, right? If we are reabsorbing all this water, that's going to bring our blood volume up, which is going to increase blood pressure. Other signs and symptoms include headache and weakness. In terms of the labs we'll see with this condition, because we're reabsorbing all of this sodium and water, we're going to have hypernatremia. And because we're getting rid of all this potassium, we're going to have hypokalemia, which can be dangerous to the patient. Anytime we have abnormally high or low levels of potassium, that places the patient at risk for life-threatening dysrhythmias. Aldosterone will be elevated in these patients, which makes sense because we're talking about hyperaldosteronism. And then in terms of diagnosis, we can do a CT scan of the adrenal gland. And then treatment may include an adrenalectomy. Also, we can give the patient a potassium-sparing diuretic, which is spironolactone. So that will help get rid of that excess fluid, but retention of potassium, which is important for this patient. And then in terms of nursing care, we're definitely going to want to monitor the patient's blood pressure, their I's and O's, and their potassium levels. And then we want to encourage that patient to consume a low-sodium and high-potassium diet in order to help balance those electrolyte levels.

Okay. So that's it for this video. When I come back, we will start talking about thyroid disorders. Thanks so much for watching!


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