skip to main content

Phaeochromocytoma — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHypertension & Preventive CardiologyPhaeochromocytomaEECC

A 40-year-old woman presents with refractory hypertension (BP 190/110 mmHg on triple therapy), episodic headaches, palpitations, and diaphoresis. Twenty-four-hour urinary metanephrines are markedly elevated. CT abdomen shows a 4 cm right adrenal mass. What is the essential preoperative pharmacological preparation before surgical removal?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Alpha-adrenoceptor blockade with phenoxybenzamine or doxazosin for at least 10-14 days before surgery

Phaeochromocytoma requires careful preoperative alpha-adrenoceptor blockade (phenoxybenzamine, a non-competitive alpha-blocker, or doxazosin, a selective alpha-1 blocker) for at least 10-14 days before adrenalectomy to prevent perioperative hypertensive crises. Beta-blockers should never be started before adequate alpha-blockade as they can cause unopposed alpha-mediated vasoconstriction and precipitate a hypertensive crisis. Once alpha-blockade is established, a beta-blocker may be added for tachycardia control. Volume expansion with oral salt loading and fluids is also recommended preoperatively. The 2024 ESC Hypertension Guidelines emphasise this stepwise pharmacological preparation.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension; Endocrine Society Guidelines on Phaeochromocytoma