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% Document Info
\author{JanePorter (janeporter)}
\pdfinfo{
  /Title (pheochromocytoma.pdf)
  /Creator (Cheatography)
  /Author (JanePorter (janeporter))
  /Subject (Pheochromocytoma Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pheochromocytoma Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{JanePorter (janeporter)} via \textcolor{DarkBackground}{\uline{cheatography.com/120660/cs/21936/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}JanePorter (janeporter) \\
  \uline{cheatography.com/janeporter} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 4th March, 2020.\\
   Updated 4th March, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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% www.emerson.emory.edu/services/latex/latex_169.html
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Catecholamine Secreting Tumor}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Occurence:}} 90\% of the time is isolated; 10\% familial. Pts are usually 30-40 years old upon diagnosis. 80\% of the time occur within adrenal medulla or at organ of Zuckerkandl (near the aortic bifurcation); 2\% at the neck and thorax.} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{NE: Epi secretion ratio = 85:15 (opposite of normal adrenal secretion)} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Mortality Rate with surgery:}} 0-3\%} \tn 
% Row Count 8 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Sign and Symptoms:}} HTN, sweating, headache, pallor, palpitations, orthostatic hypotension. NE (alpha) - systolic \& diastolic HTN with reflex bradycardia. Epi (beta) - systolic HTN and diastolic hypotension with tachycardia. Cardiomyopathy - dilated and hypertrophic and left ventricular outflow obstruction. Coronary vasoconstriction leads to decreased coronary blood flow. ECG changes: ST segment changes, T wave changes, prolonged QT, peaked P waves, left axis deviation and dysrhythmias. Increased blood glucose due to glycogenolysis and inhibited insulin release.} \tn 
% Row Count 20 (+ 12)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Diagnosis:}} Pts with low probability: 24-hour urine collection will show vanillymandelic acid (metabolites of NE/Epi). Pts with high probability: plasma free metanephrines (catecholamine metabolites). Clonidine supression test: no effect to clonidine means positive for pheochromocytoma} \tn 
% Row Count 26 (+ 6)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Pre-op Management:}} Phenoxybenzamine: (non-competitive alpha 1 antagonist) has a long duration so, discontinue 24-48 hours pre-op. Prazosin and doxazosin: (alpha 1 competitive antagonist) short acting and causes less tachycardia. Labetalol: (non-selective beta-blocker) for heart rates greater than 120 bpm. Esmolol:(Beta 1 selective) good for Epi secreting pheo's. \seqsplit{Alpha-methylparatyrosine:} inhibits tyrosine hydroxylase - rate limiting enzyme. Nifedipine, diltiazem, verapamil, captopril: (CCBs) decrease catecholamine release. ACE inhibitors.} \tn 
% Row Count 37 (+ 11)
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Catecholamine Secreting Tumor (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Intra-op Management:}} {\emph{Histamine releasers:}} morphine and atracurium. {\emph{Catacholamine inducers:}} atropine, pancuronium, succinylcholine. {\emph{Hypertension}} - Nitroprusside (direct vasodilator). Phentolamine (competitive alpha blocker). Nitroglycerine can cause tachycardia and you need a large dose. Labetalol (epi secreting tumors). Magnesium - decreased catecholamine release, decreases sensitivity of the alpha receptor to NE/Epi and is a direct vasodilator. {\emph{Ventricular Arrhythmias}} - Lidocaine or Beta blockers. {\emph{Fluids}} - LR, NS, D5W. Glucocorticoids.} \tn 
% Row Count 12 (+ 12)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Post-op Management:}} Take 7-10 days for plasma catecholamine levels to decrease. {\emph{Goal BP}} : \textless{}165/90 \textgreater{}80/45 mmHg for the first 48 hours.} \tn 
% Row Count 15 (+ 3)
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\begin{tabularx}{17.67cm}{x{3.0366 cm} x{3.5427 cm} x{10.2907 cm} }
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\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Presentation with different catecholamine release}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{NE}} & {\bf{EPI}} & {\bf{Other SS}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
HTN & \seqsplit{Palpitations} & Dysrhthmias \tn 
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\seqsplit{Headache} & \seqsplit{Tachycardia} & Cardiomyopathy \tn 
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\SetRowColor{white}
\seqsplit{Sweating} & \seqsplit{Panic/Anxiety} & MI \tn 
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\SetRowColor{LightBackground}
Pallor & Tremors & Encephalopathy \tn 
% Row Count 8 (+ 1)
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\SetRowColor{white}
\seqsplit{Bradycardia} & \seqsplit{Hyperglycemia} & Stroke \tn 
% Row Count 10 (+ 2)
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\SetRowColor{LightBackground}
 &  & Renal Insufficiency \tn 
% Row Count 11 (+ 1)
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\SetRowColor{white}
 &  & Tumar mass effects (i.e. compression) \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\par\addvspace{1.3em}



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