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Phaeochromocytoma — SCE Endocrinology MCQ

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ModerateAdrenalPhaeochromocytomaSCE Endocrinology

A 38-year-old man has recurrent headache, sweating and palpitations with blood pressure 210/118 mmHg during attacks. Plasma metanephrines are three times the upper reference limit and CT shows a 4 cm adrenal lesion. What is the most appropriate management before surgery?

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Correct answer: D — Start alpha-adrenoceptor blockade before considering beta-blockade

Start alpha-adrenoceptor blockade before considering beta-blockade is best because phaeochromocytoma requires pre-operative alpha-blockade to prevent catecholamine-driven hypertensive crisis. The alternatives are less appropriate because beta-blocker monotherapy risks unopposed alpha vasoconstriction; unprepared surgery is dangerous; spironolactone treats aldosteronism; metyrapone treats cortisol excess. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Endocrine Society phaeochromocytoma/paraganglioma guideline