TY - CHAP M1 - Book, Section TI - Chapter 76. Pheochromocytoma A1 - Myneni, Neelima A2 - Atchabahian, Arthur A2 - Gupta, Ruchir PY - 2013 T2 - The Anesthesia Guide AB - Tumors of the adrenal medulla that produce, secrete, and store catecholaminesNorepinephrine is predominantly secreted along with small amounts of epinephrine, and occasionally dopaminePerioperative mortality has been reported to be as high as 45% from cardiovascular causes, and directly correlates with tumor size and degree of catecholamine secretion. With appropriate management, mortality is very lowSurgical exploration is curative in 95% of cases, with reduction in mortality to 3%Rule of 10s: 10% are malignant, 10% are extra-adrenal, 10% are bilateralOccasionally associated with syndromes: MEN IIA, MEN IIB, von Hippel-Lindau disease, or in rare cases, Von Recklinghausen’s disease, tuberous sclerosis, and Sturge-Weber syndromeTypical presentation is a young adult in 30s to 50s with sustained hypertension (or occasionally paroxysmal), tachycardia, palpitations, tremor, sweating, flushing, hyperglycemia (secondary to α-stimulated inhibition of insulin secretion)Cerebral vascular accidents and myocardial infarction are possibleIn patients with chest pain and dyspnea, catecholamine-induced cardiomyopathy should be ruled out. The cardiomyopathy may be reversible if the catecholamine stimulation is removed early before fibrosis has occurredDiagnosis: elevated plasma levels of free catecholamines and elevated urinary vanillylmandelic acid (VMA) levels along with CT findingsMIBG (methyl-iodo-benzyl-guanidine) scan may be needed to locate tumor(s) SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/12/13 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57261489 ER -