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Phaeochromocytoma — RACP Adult Medicine MCQ

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ModerateEndocrinologyPhaeochromocytomaRACP Adult Medicine

A 58-year-old man presents with a phaeochromocytoma confirmed on biochemistry (elevated plasma metanephrines) and CT (5 cm right adrenal mass). He is symptomatic with episodes of headache, sweating, and palpitations. BP is 185/110 mmHg. What is the most appropriate pre-operative preparation?

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Correct answer: A — Alpha-blocker (phenoxybenzamine) first then add beta-blocker

Pre-operative alpha-blockade (phenoxybenzamine or doxazosin) for at least 10–14 days before surgery is essential to prevent intra-operative hypertensive crisis. Beta-blockers are added ONLY after adequate alpha-blockade (to prevent unopposed alpha stimulation and hypertensive crisis from beta-blocker alone). Liberal salt and fluid intake to expand intravascular volume.

Reference: Endocrine Society – 2014 – Phaeochromocytoma Guidelines; ESA 2024