Caring for Patients With Pheochromocytomas in the Perioperative Setting

Pheochromocytomas are rare, complex catecholamine-secreting tumors of the adrenal medulla. Patients with pheochromocytomas may experience episodes of life-threatening hypertension, and untreated tumors can be fatal. The nonspecific signs and symptoms (eg, headaches, palpitations, sweating) make diagnosing these tumors difficult. A comprehensive patient history, clinical evaluation during episodic hypertension, and biochemical test results can facilitate a definitive diagnosis. The only curative treatment is minimally invasive tumor removal. Because the tumor may recur, patients require follow-up visits for approximately 10 years after surgery. Preoperative evaluations can include cardiac and imaging studies and genetic testing. Preoperative preparation involves controlling hypertension and planning for hypotension after tumor removal. Perioperative nurses should be prepared to assist anesthesia professionals with placing invasive hemodynamic monitors and responding to blood pressure changes. An interdisciplinary team can create a guideline or protocol for nurses to follow to enhance outcomes when caring for patients with pheochromocytomas.