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Pheochromocytoma preoperative preparation — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CarePheochromocytoma preoperative preparationUSMLE Step 3

A 46-year-old woman has episodic palpitations, headache, and sweating. Blood pressure is 168/96 mm Hg during episodes and 126/76 mm Hg between episodes. Plasma free metanephrines are markedly elevated. CT shows a 3-cm adrenal mass. Which of the following is the most appropriate next step in management?

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Correct answer: B — Start alpha-adrenergic blockade before surgery

Pheochromocytoma requires preoperative alpha blockade and volume expansion before surgery. Beta blockade, if needed, is added after alpha blockade to avoid unopposed alpha stimulation.

Reference: Endocrine Society Pheochromocytoma and Paraganglioma Guideline