Pheonix India嗜铬细胞瘤凤凰印度课件.ppt

Maintenance(During surgery) Propranolol/Short acting beta blocker Esmolol may be required during this period if there is persistent tachycardia/premature ventricular contractions Ligation of the tumors venous drainage ↓ circulating catecholamine causing hypotension After ligation of all venous drainage arterial pressure commonly declines r/t ↑CO, ↓ SVR Treatment ↓ VA ↑ IVF Phenylephrine or nor epinephrine Postop 1) Invasive lines should stay intact. Pt still at risk for liable BP. 2) Pt susceptible to hypotension that is refractory to fluid volume expansion 3) Still have high volumes of circulating catecholamine despite tumor resection 4) Catecholamine levels normalize after several days. 75% of pts BP returns to normal after 10 days 5) Prone to Hypoglycemia. Secondary to suppression of β-cell function disappears after the tumor is removed Pheo Pregnancy Diagnosis with 24h urine collections and MRI No stimulation tests, no MIBG if pregnant 1st 2nd trimester ( 24 weeks): Phenoxybenzamine + ?blocker prep Resect tumor laprascopically 3rd trimester: Phenoxybenzamine + ?blocker prep When fetus large enough: cesarian section followed by tumor resection Addisons disease Addisons disease is characterized by decreased or absent glucocorticoid secretion, usually combined with mineralocorticoid insufficiency. It can be primary or secondary and may present as an acute, chronic, or acute-on-chronic illness. The most common cause is autoimmune. A) Clinical features Postural hypotension dizziness Hyperkalemia Hyponatremia Hypoglycemia Nausea, vomiting, diarrhea, and weight loss. Decreased body hair. Pigmentation especially in areas exposed to the sun. Can be associated with pernicious anemia, myasthenia gravis, and vitiligo May not be clinically obvious until a significant stress occurs B) Investigations- 1) Low serum glucose. 2)