Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
30 - Pheochromocytoma
Published online by Cambridge University Press: 12 January 2010
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
Summary
Although pheochromocytomas are not a common medical/surgical problem (they are estimated to cause only 0.1% to 0.5% of all cases of hypertension, and are operated on only once or twice per year in most centers), medical consultants are likely to be asked to evaluate and prepare for surgery patients with suspected pheochromocytomas at some time during their careers. Because catecholamines have major regulatory effects on many different body systems, it is vital that these be anticipated and properly managed in the perioperative period. Pheochromocytomas are associated with an increased risk of adverse reactions to many commonly prescribed drugs and clinicians must also be aware of this potential hazard. The surgical removal of a pheochromocytoma has great potential for intra- and postoperative complications because of the release of catecholamines during manipulation or stimulation of the tumor.
Pathophysiology
Pheochromocytomas arise from chromaffin cells of the neural crest that migrate to form the adult adrenal medulla and sympathetic ganglia. These cells synthesize catecholamines through a series of enzymatically controlled steps, starting with the conversion of tyrosine to dihydroxyphenylalanine (dopa) by tyrosine hydroxylase. This is the rate-limiting step in catecholamine synthesis. Dopa is then converted to dopamine, which is subsequently decarboxylated to norepinephrine. The methylation of norepinephrine to epinephrine is accomplished through the action of phenylethanilamine-N-methyl transferase, an enzyme that is induced by glucocorticoids that reach the adrenal medulla in high concentrations through the corticomedullary venous sinuses from the adrenal cortex. Norepinephrine and epinephrine are the major products of most pheochromocytomas.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 383 - 386Publisher: Cambridge University PressPrint publication year: 2006