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Phaeochromocytoma — SCE Endocrinology MCQ

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ModerateAdrenalPhaeochromocytomaSCE Endocrinology

A 43-year-old woman has episodic headache, sweating and palpitations. Blood pressure during attacks is 220/118 mmHg. Plasma normetanephrine is four times the upper limit of normal and MRI shows a 4 cm adrenal mass. What is the most appropriate management?

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Correct answer: C — Start alpha-blockade before beta-blockade and surgery

Phaeochromocytoma requires alpha-blockade before beta-blockade or surgery to avoid unopposed alpha-adrenergic vasoconstriction. Adrenal biopsy is hazardous and inappropriate before biochemical exclusion of phaeochromocytoma. The pearl is that preparation prevents intraoperative catecholamine crisis.

Reference: Endocrine Society phaeochromocytoma guideline, BNF