# Situation: A 38-year-old man has attacks of pounding headache, sweating, and palpitations, with blood pressure up to 220/120 mmHg during attacks. Plasma free metanephrines are high, and imaging shows a right adrenal mass. Adrenalectomy is planned in 2 weeks. During the admission assessment, the nurse avoids deep palpation of his abdomen. What is the reason?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630508  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 38-year-old man has attacks of pounding headache, sweating, and palpitations, with blood pressure up to 220/120 mmHg during attacks. Plasma free metanephrines are high, and imaging shows a right adrenal mass. Adrenalectomy is planned in 2 weeks.

During the admission assessment, the nurse avoids deep palpation of his abdomen. What is the reason?

## 보기

1. Palpation over the kidney can trigger severe flank pain
2. Palpation can spread tumor cells into the bloodstream
3. Deep palpation can rupture the capsule of the mass
4. Pressure on the tumor can release a catecholamine surge **✔ 정답**

**정답: 4**

## 해설

A pheochromocytoma stores large amounts of catecholamines, and pressure on the tumor can release them suddenly, causing a hypertensive crisis with headache, palpitations, and sweating. Abdominal pressure, straining, and certain drugs are avoided for the same reason.

## 심화 해설

Why deep palpation is avoided
A pheochromocytoma is a tumor of the adrenal medulla that stores large amounts of catecholamines, mainly adrenaline (epinephrine) and noradrenaline (norepinephrine). Mechanical pressure on the tumor can squeeze these hormones into the bloodstream all at once. Deep abdominal palpation can trigger a sudden catecholamine surge and a hypertensive crisis. His attacks already reach 220/120 mmHg, so a provoked surge could cause stroke, myocardial ischemia, arrhythmia, or pulmonary edema.

What a catecholamine surge looks like
The classic triad during an attack is pounding headache, sweating, and palpitations, often with pallor, tremor, anxiety, and a severe rise in blood pressure. The same triggers that release catecholamines are avoided throughout his care: abdominal pressure, straining at stool, heavy lifting, sudden position changes, and certain drugs such as some anesthetic agents, metoclopramide, and beta blockers given before alpha blockade. The nurse also avoids stimulants such as caffeine and promotes a calm environment.

| Reason offered | Correct? |
| --- | --- |
| Palpation triggers severe flank pain | No: pain is not the concern |
| Palpation spreads tumor cells | No: not the reason |
| Palpation ruptures the capsule | No: not the concern |
| Pressure releases a catecholamine surge | Yes |

Why the other reasons are wrong
Flank pain may occur with large adrenal or kidney masses, but the danger of palpation here is a rise in blood pressure, not pain. The idea of spreading tumor cells applies more to certain tumors, such as Wilms tumor in children, where palpation is avoided to prevent rupture and seeding; it is not the reason in pheochromocytoma. Capsule rupture is likewise not the main concern. Watch out! Do not confuse the "no abdominal palpation" rule in pheochromocytoma with the same rule in Wilms tumor; the reasons differ.

Exam takeaway
Nursing care before surgery focuses on preventing and recognizing hypertensive crises: monitoring blood pressure, avoiding triggers, giving alpha blockers as ordered, and reporting attack symptoms promptly. Key point! In pheochromocytoma, avoid deep abdominal palpation because pressure on the tumor can release catecholamines and cause a hypertensive crisis.

## 임상 시나리오

Pheochromocytoma PrecautionsAvoiding catecholamine surges
A pheochromocytoma stores large amounts of catecholamines. Pressure on the tumor can release them suddenly and cause a hypertensive crisis.

Attack signs: pounding headache, sweating, palpitations, and blood pressure up to 220/120 mmHg.

Avoid deep abdominal palpation, straining, heavy lifting, stimulants, and drugs that can trigger release.

CautionA hypertensive crisis can cause stroke, myocardial ischemia, arrhythmia, or pulmonary edema; report attack symptoms immediately.

## 핵심 개념

- **Pheochromocytoma** — A catecholamine-secreting tumor of the adrenal medulla causing episodic or sustained hypertension.
- **Catecholamines** — Hormones such as adrenaline (epinephrine) and noradrenaline (norepinephrine) that raise heart rate and blood pressure.
- **Hypertensive crisis** — A severe, sudden rise in blood pressure that can damage the brain, heart, and kidneys.
- **Plasma free metanephrines** — Breakdown products of catecholamines measured in blood to diagnose pheochromocytoma.

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