Adrenal Pheochromocytoma

WHAT YOU SHOULD KNOW:

• Adrenal (ah-DREE-nal) pheochromocytoma (fee-o-kro-mo-si-TO-mah) is a rare tumor of the adrenal glands. The adrenal glands are triangular-shaped glands that sit on top of the kidneys. They produce hormones and chemicals that keep blood sugar and blood pressure levels normal. With adrenal pheochromocytoma, cells grow and divide without control or order, making too much tissue. The increased tissue causes more hormones to be released in the body, which causes blood pressure to rise. Most adrenal pheochromocytomas are benign (noncancerous) and can be treated easily. They may also be malignant (cancerous) and spread to other areas of the body. An adrenal pheochromocytoma may be sporadic (occurring for the first time in a family). It may also be familial or hereditary and be caused by a disorder, such as neurofibromatosis, that runs in families.
  
  
• Signs and symptoms may include hypertension (high blood pressure), headache, palpitations (fast heartbeats), and increased sweating. Other signs may include abdominal (stomach) pain, nervousness, nausea (upset stomach), vomiting (throwing up), trouble breathing, and weight loss. Adrenal pheochromocytoma is usually diagnosed by blood or urine tests, computed tomography (CT) scan, or a magnetic resonance imaging (MRI) test. You may also need a bone scan, scintigraphy, positron emission tomography (PET) scan, or an ultrasound. Depending on the type of tumor that you have, treatment may include medicines, surgery, radiation, or chemotherapy. The chances of curing an adrenal pheochromocytoma are better when it is found and treated as early as possible.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Treatment for adrenal pheochromocytoma may cause unpleasant side effects. Some medicines may cause nausea (upset stomach), vomiting (throwing up), drowsiness (feeling sleepy), low blood pressure, or kidney problems. Surgery may cause you to bleed too much. Your stomach, intestines, blood vessels, or kidneys may get injured or burned during surgery. You could also have trouble breathing or get an infection after surgery. Even after having surgery, there is still a chance that your tumor may come back.
  
  
• Without treatment, your blood pressure may rise to dangerous levels and the symptoms that you have may worsen. This may lead to other serious and life-threatening medical problems, such as heart failure, stroke, or even sudden death. If a malignant adrenal pheochromocytoma is not treated as soon as possible, it can spread to other parts of your body. Once cancer spreads, it becomes more difficult to treat. The earlier an adrenal pheochromocytoma is treated, the better your chances are that serious medical problems may be prevented. Ask your caregiver if you are worried or have questions about your disease, care, or treatment.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Diet:

It is important that you get good nutrition and eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. Tell your caregiver if you have problems eating, or if you are getting sick to your stomach. Eat different foods from the following groups every day:

• Bread, cereal, rice and pasta.
  
  
• Vegetables.
  
  
• Fruits.
  
  
• Milk, yogurt, and cheese.
  
  
• Meat, poultry (chicken), fish, dry beans, eggs and nuts.
  
  
• Ask your caregiver how many servings of fats, oils and sweets should be included in your diet.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Glucose: This medicine may be given to increase the amount of sugar in your blood.
  
  
• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Tests:

You may have any of the following:

• Blood and urine tests: Samples of your blood and urine are sent to a lab for tests. These tests measure the amount of hormones and other chemicals in your body. You may also have
  
  
• Blood sugar checks: Your blood sugar may be checked many times each day. This is usually done before meals and at bedtime. Your finger is pricked to draw blood and the blood is put into a glucose monitor (glucometer). A glucometer is a small hand-held machine used to test the amount of sugar in your blood.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Genetic screening: Genetic screening may be done to confirm if you or other family members have adrenal pheochromocytoma. This will also give your caregiver more information on how to treat your adrenal pheochromocytoma.
  
  
• Imaging tests: You may be given dye through an IV in your vein during one of your tests. The dye helps cancer show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
  • Bone scan: This test can show if cancer has spread to the bones. This test may be done if your caregiver suspects you have the malignant form of adrenal pheochromocytoma.
    
    
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
    
    
  • Computerized tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your chest, abdomen, or hip area.
    
    
  • Magnetic resonance imaging test: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your chest, abdomen, and adrenal glands. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. Doing this can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Positron emission tomography scan: This test is also called a PET scan. A PET scan shows how much blood and oxygen is flowing to an area of the adrenal gland and other parts of the abdomen. It may also show areas where there is cancer.
    
    
  • Ultrasound: An ultrasound is a test that looks inside your abdomen. Sound waves are used to show pictures of your adrenal glands, kidneys, or other organs on a TV-like screen.
    
    
  • Scintigraphy: This is a test that looks at the flow or movement of blood through the adrenal glands. You will be given a small amount of dye in an IV. Pictures are then taken of your adrenal glands, abdominal organs, and blood vessels.

Treatment options:

Treatment of adrenal pheochromocytoma depends on the signs, symptoms, and type of tumor that you have. You may have any of the following:

• Surgery: Caregivers may do open or laparoscopic surgery to remove a part or all of your adrenal gland. Open surgery is done by making an incision (cut) in your abdomen (stomach). Laparoscopic surgery is done by inserting a scope into small cuts. The scope is a long tube with a magnifying glass, a camera, and a light on the end.
  
  
• Additional treatment: If you have a malignant pheochromocytoma, you may also have the following:
  
  
  • Chemotherapy:
    
    
    • This medicine, often called chemo, is used to treat cancer. It works by killing tumor cells. Chemotherapy may also be used to shrink lymph nodes that have cancer in them. Once the tumor is smaller, you may need surgery to cut out the rest of the cancer.
      
      
    • Many different chemotherapy medicines are used to treat cancer. You may need blood tests often. These blood tests show how your body is doing and how much chemotherapy is needed. Chemotherapy can have many side effects. Caregivers will watch you closely and will work with you to decrease side effects. Chemotherapy can cure some cancers. Even if the chemotherapy does not cure your cancer, it may help you feel better or live longer.
    
    
  • Radiation: Radiation shrinks tumors and kills cancer cells with x-rays or gamma rays. Radiation may be given after surgery to kill cancer cells that were not removed. It may also be given alone or with chemotherapy to treat cancer.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Adrenal Pheochromocytoma (Inpatient Care)