Phaeochromocytoma — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicinePhaeochromocytomaRACP Adult Medicine

A 35-year-old woman presents with episodic headaches, sweating, and palpitations. Her BP is 220/130 mmHg. Plasma free metanephrines are markedly elevated. CT abdomen shows a 5 cm right adrenal mass. What medication must be commenced BEFORE any surgical intervention?

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Correct answer: A — Phenoxybenzamine

Alpha-blockade with phenoxybenzamine (a non-competitive, irreversible alpha-blocker) must be commenced at least 10–14 days before surgery for phaeochromocytoma. Beta-blockers should ONLY be started AFTER adequate alpha-blockade to prevent unopposed alpha-receptor stimulation causing hypertensive crisis. Phenoxybenzamine is preferred over competitive alpha-blockers (prazosin, doxazosin) for pre-operative preparation in Australia.

Reference: eTG – 2025 – Endocrinology; Endocrine Society – 2014 – Phaeochromocytoma Guidelines