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Phaeochromocytoma Pre-Op Readiness — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesPhaeochromocytoma Pre-Op ReadinessRACP Adult Medicine

A 45-year-old woman with known pheochromocytoma is being prepared for laparoscopic adrenalectomy. She has been on phenoxybenzamine for 3 weeks and atenolol for 1 week. Her BP is 120/75 mmHg with orthostatic drop to 100/60 mmHg. HR is 72 bpm. She has gained 2 kg in weight and nasal congestion has developed. What do these signs indicate?

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Correct answer: E — Heart failure from phenoxybenzamine

Adequate pre-operative alpha-blockade for phaeochromocytoma is indicated by: (1) seated BP <130/80 mmHg, (2) orthostatic hypotension (systolic drop >20 mmHg but not symptomatic), (3) nasal congestion (alpha-blockade of nasal mucosal vessels), (4) mild peripheral oedema/weight gain (from alpha-mediated vasodilation and volume expansion). These signs indicate sufficient alpha-receptor blockade to prevent intraoperative hypertensive crisis. The patient should be volume-loaded with liberal salt and fluid intake in the days before surgery. Surgery should proceed when these criteria are met.

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