Phaeochromocytoma Pre-Op — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesPhaeochromocytoma Pre-OpRACP Adult Medicine

A 60-year-old man with previously diagnosed pheochromocytoma presents for pre-operative assessment. He has been on phenoxybenzamine for 2 weeks. His blood pressure is now 130/80 mmHg but resting heart rate is 110 bpm. What is the appropriate next step?

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Correct answer: C — Commence atenolol (beta-blocker)

After adequate alpha-blockade with phenoxybenzamine (evidenced by normalised BP and nasal congestion/orthostatic hypotension), a beta-blocker should be added if tachycardia develops. Tachycardia results from both catecholamine excess and reflex tachycardia from alpha-blockade. Beta-blockers must NEVER be started before alpha-blockade, as unopposed alpha-stimulation can cause a hypertensive crisis. Atenolol or propranolol are commonly used. Target HR is <80 bpm.

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