Once a diagnosis of Pheochromocytoma or paraganglioma is made, removal of the tumor requires medical management that involves Nephrology involvement heavily.
There are basically two arms to the preparation. One is controlling the hypertension and second is making their blood pressure salt dependent and responding to fluids when they are post op. No trials have been ever conducted on any of these approaches but from years of experience of many physicians, this works.
What agents to use for controlling the BP? - Alpha blockade first, followed by beta blockaded. Never do the reverse as it will lead to unopposed alpha and more HTN. Usually this can be started 7-12 days prior to surgery and then towards the date of the surgery, recommended high salt diet to ensure good dependence and response to fluids as the longer you have alpha blocked them, the less they will respond to pressors once the tumor is removed.
The alpha blockers of choice are:- non specific alpha blocker and longer acting Phenoxybenzamine, or specific short actings like doxazosin or terazosin. The Beta blockers used are propranolol or atenolol. Sometimes, metyrosine is used, which inhibits the catecholamine synthesis( the side effect profile- not great).
Some patients with persistent HTN, might need IV phentolamine as well pre op for 24-48 hours followed by IVF at high rates prior to surgery and very close monitoring of the HTN during surgery via anesthesia.
Two most commonly feared post op complications are:
Hypotension:- hence we try to make them fluid dependent.
Hypoglycemia:- Due to fall of catecholamine secretion and may need glucose infusion.
- ► 2018 (27)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- Nephronpower Views
- HyperKalemia Challenge
- TOPIC DISCUSSION: Residual renal function???
- AST Fellows Symposium on Transplantation Medicine
- CONSULT ROUNDS: Ranolazine and the Kidney?
- CONSULT ROUNDS: A primer on CVVHDF orders
- CLINICAL CASE 33, ANSWERS and SUMMARY
- Who gets kidney first?- the thoughts in 2011
- IN THE NEWS- E Nephrology
- Concept Map of Viruses and the diseases in the kid...
- TOPIC DISCUSSION: What causes Foamy Urine?
- ATC and NKF Abstracts 2011 are on line for viewing...
- Kidney transplant and donation cancer risks
- Concept Map of HIV, Hep C and Hep B and the Kidney...
- Viruses and the Kidney, a primer! ( a case based a...
- Concept Map of Viruses and the Kidney, a general m...
- CONSULT ROUNDS: Preparing For a Pheochromocytoma R...
- Kidney Transplant Recipient Infected With HIV From...
- TOPIC DISCUSSION: Contraction Alkalosis or CDMA?
- TOPIC DISCUSSION: Lactate levels and B2 agonists? ...
- CONSULT ROUNDS: Cefepime Neuro-toxicity and the Ne...
- More Pediatric Grand Rounds from www.pediatric-nep...
- Olmesartan for Patients with Diabetes
- ASN Review course 2011
- Hematuria Post Kidney Transplantation
- Notes from Dr. RW: Hyponatremia update
- Paraproteins and the Kidney
- Concept Map of Hypernatremia
- TOPIC DISCUSSION: TB and the Kidney
- Virtual Library ( the Welch Library) Part 2
- IN THE NEWS: Belimumab and Lupus
- Top Ten Reasons to Love you Kidneys
- Virtual Library ( the Welch Library) Part 1
- Elimination of anti rejection medicaitons
- Smoldering vs Active Myeloma
- Tissue Engineering Renal Tissue
- Concept Map of Hyponatremia
- Concept Map of BK Nephritis Treatment
- Bortezomib for desensitization!
- JOURNAL CLUB: FHN Trial
- Complications of Peritoneal Dialysis
- TOPIC DISCUSSION: Amyloidosis and Factor X deficie...
- CLINICAL CASE 34, ANSWER AND SUMMARY
- IN THE NEWS--> DOSE TRIAL
- ANCA VASCULITIS
- CONSULT ROUNDS: An approach to orthostatic hypoten...
- In the News: Transplant rules changing
- Concept Map of Kidney Injury in hematopoietic Stem...
- Growing Kidneys
- ▼ March (49)
- ► 2010 (461)