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Phaeochromocytoma crisis — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesPhaeochromocytoma crisisSCE Acute Medicine

A 46-year-old woman with an adrenal mass has episodic headache and sweating, then develops BP 246/132 mmHg, chest pain and pulmonary oedema after metoclopramide. Which vasoactive strategy is best while intensive endocrine care is arranged?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Use titratable intravenous alpha blockade or vasodilation before any beta blockade

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

E is correct. Phaeochromocytoma hypertensive crisis needs monitored, rapidly titratable vasodilation, classically intravenous phentolamine, nitroprusside or nicardipine, with expert fluid and cardiac management. Beta blockade may be added for persistent tachyarrhythmia only after effective alpha blockade; giving propranolol or beta-dominant labetalol first can cause unopposed alpha vasoconstriction and paradoxical worsening. Oral phenoxybenzamine is too slow as sole acute therapy, while adrenaline intensifies catecholamine excess. Definitive surgery follows stabilisation whenever feasible.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC7465968/