Mayo Classification Tolvaptan Suitability — ESENeph MCQ

Correct answer: C — Correct contracted volume before vasodilation and tumour removal

The best answer is “Correct contracted volume before vasodilation and tumour removal”. Chronic vasoconstriction contracts plasma volume; alpha blockade unmasks this deficit, and abrupt catecholamine withdrawal at tumour removal can cause profound hypotension without repletion. “Increase catecholamine release to maintain pressure during anaesthetic induction” is less appropriate because the goal is volume repletion, not greater catecholamine exposure “Replace alpha blockade before tumour resection is undertaken” is less appropriate because both alpha blockade and volume preparation are required “Reduce tumour size during the preoperative preparation interval” is less appropriate because volume expansion does not alter tumour biology “Reduce metanephrine excretion before confirmatory biochemical testing” is less appropriate because diagnostic biochemistry is not the purpose

Reference: NHS guidance on phaeochromocytoma: https://www.nhs.uk/conditions/phaeochromocytoma/