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Phaeochromocytoma — RCPSC IM MCQ

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HardEndocrinologyPhaeochromocytomaRCPSC IM

A patient with markedly elevated metanephrines has a 3-cm adrenal pheochromocytoma and is being prepared for surgery. Which sequence is appropriate?

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Correct answer: A — Establish alpha blockade and volume repletion before adding beta blockade if needed

The best answer is “Establish alpha blockade and volume repletion before adding beta blockade if needed”. Alpha blockade precedes beta blockade to prevent unopposed alpha-adrenergic vasoconstriction and crisis. Volume repletion addresses chronic catecholamine-mediated contraction; surgery follows appropriate preparation. The final regimen is individualized to blood pressure, arrhythmia, cardiomyopathy and orthostasis, with anesthesia and endocrine teams coordinating surgery.

Reference: Hypertension Canada, 2025 primary-care guideline: https://hypertension.ca/guidelines/