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Phaeochromocytoma Preoperative Preparation — EECC MCQ

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ModerateHypertension & Preventive CardiologyPhaeochromocytoma Preoperative PreparationEECC

A 30-year-old woman with hypertension and episodes of headache, palpitations, and sweating has elevated plasma metanephrines (normetanephrine 5x ULN). CT abdomen shows a 4 cm right adrenal mass. What is the diagnosis and preoperative preparation?

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Correct answer: A — Phaeochromocytoma — alpha-blockade (phenoxybenzamine or doxazosin) must be started at least 10-14 days before surgical resection, followed by beta-blockade after adequate alpha-blockade to prevent hypertensive crisis during tumour manipulation

Phaeochromocytoma presents with the classic triad (present in <50% of cases): episodic headache, sweating, and palpitations with hypertension (sustained or paroxysmal). Diagnosis: elevated plasma free metanephrines (>2x ULN is highly specific) or 24-hour urinary metanephrines/catecholamines. Localisation: CT/MRI (>90% sensitivity for adrenal tumours ≥1 cm). Critical preoperative preparation: (1) alpha-blockade FIRST (phenoxybenzamine — irreversible, or doxazosin — competitive) for at least 10-14 days to normalise BP and expand volume; (2) THEN beta-blockade (only AFTER adequate alpha-blockade — beta-blockade alone causes unopposed alpha-mediated vasoconstriction and dangerous hypertensive crisis); (3) Liberal salt and fluid intake. Laparoscopic adrenalectomy is the standard surgical approach.

Reference: ESC (2024): Hypertension Guidelines; Endocrine Society Phaeochromocytoma Guidelines