# 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. Three hours after laparoscopic adrenalectomy, he is drowsy, sweaty, and tremulous. His blood pressure is 98/60 mmHg, heart rate 104 beats/min, and oxygen saturation 97% on room air. Which assessment should the nurse obtain FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630511  
> 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.

Three hours after laparoscopic adrenalectomy, he is drowsy, sweaty, and tremulous. His blood pressure is 98/60 mmHg, heart rate 104 beats/min, and oxygen saturation 97% on room air. Which assessment should the nurse obtain FIRST?

## 보기

1. A capillary blood glucose level **✔ 정답**
2. A repeat blood pressure in 15 minutes
3. A pain score on a 0-to-10 scale
4. The drain output since surgery

**정답: 1**

## 해설

After removal of a pheochromocytoma, the sudden fall in catecholamines releases the brake on insulin secretion, and rebound hypoglycemia is common in the first 24–48 hours. Sweating, tremor, and drowsiness with a mildly low blood pressure should prompt an immediate capillary glucose check, since these signs can be mistaken for a catecholamine surge or pain.

## 심화 해설

Rebound hypoglycemia after tumor removal
Catecholamines from a pheochromocytoma raise glucose in two ways: they stimulate glucose release from the liver and they suppress insulin secretion through alpha-adrenergic effects on the pancreatic beta cells. When the tumor is removed, catecholamine levels fall suddenly. The brake on insulin release is lifted, insulin rises, and glucose can drop sharply. Rebound hypoglycemia is a well-known complication in the first 24–48 hours after surgery. Drowsiness, sweating, and tremor after removal of a pheochromocytoma call for an immediate capillary glucose check.

Why glucose is checked first
His signs combine neuroglycopenic features (drowsiness) with adrenergic features (sweating, tremor). His blood pressure of 98/60 mmHg and heart rate of 104 beats/min are mildly abnormal, and his oxygen saturation of 97% is normal, so airway and breathing are not the immediate concern. A capillary glucose takes seconds, explains all his signs, and leads to immediate treatment if low. Untreated hypoglycemia can progress to seizures and loss of consciousness, especially in a client recovering from anesthesia.

| Assessment | Explains his signs? | Comment |
| --- | --- | --- |
| Capillary blood glucose | Yes | Fast, explains drowsiness, sweating, tremor |
| Repeat blood pressure in 15 minutes | No | Monitored, but delays the key check |
| Pain score | Partly | Pain causes sweating, not drowsiness |
| Drain output | Partly | Detects bleeding, but signs point to a metabolic cause |

Why the other assessments come later
Blood pressure monitoring is essential after adrenalectomy because hypotension is common, but a repeat reading does not explain his neurologic and adrenergic signs. Pain can cause sweating and tachycardia but would not usually make him drowsy. Drain output helps detect bleeding, which could cause hypotension and tachycardia, but bleeding does not explain tremor and sweating as well as hypoglycemia does, and glucose can be checked in seconds. Watch out! After pheochromocytoma surgery, sweating and tremor can be mistaken for a catecholamine surge or pain; low glucose must be excluded first.

Exam takeaway
Postoperative monitoring after pheochromocytoma removal includes frequent blood pressure checks for hypotension, glucose monitoring for rebound hypoglycemia, and fluid balance. Key point! The sudden fall in catecholamines after tumor removal releases insulin and can cause rebound hypoglycemia in the first 24 to 48 hours.

## 임상 시나리오

Rebound Hypoglycemia After AdrenalectomyPheochromocytoma postoperative care
Catecholamines suppress insulin. After the tumor is removed, insulin rises and rebound hypoglycemia is common in the first 24–48 hours.

Drowsiness, sweating, and tremor with blood pressure 98/60 mmHg call for an immediate capillary blood glucose check.

Continue frequent blood pressure monitoring for hypotension and monitor fluid balance.

CautionSweating and tremor can be mistaken for pain or a catecholamine surge; check glucose first.

## 핵심 개념

- **Rebound hypoglycemia** — A fall in blood glucose after a sudden loss of hormones that had been suppressing insulin or raising glucose.
- **Neuroglycopenic signs** — Symptoms from low glucose supply to the brain, such as drowsiness, confusion, and seizures.
- **Adrenergic signs** — Symptoms from sympathetic activation, such as sweating, tremor, and palpitations.
- **Laparoscopic adrenalectomy** — Minimally invasive surgical removal of an adrenal gland through small abdominal incisions.

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