A 44-year-old man presents with episodic headaches, palpitations, and profuse sweating. BP during an attack is 220/120 mmHg. 24-hour urine metanephrines are markedly elevated. CT abdomen reveals a 4.5 cm right adrenal mass. Which of the following is the correct sequence of management before adrenalectomy?

• A Beta-blockade first, then alpha-blockade, then surgery
• B Combined alpha and beta blockade simultaneously, then immediate surgery
• C Alpha-blockade first, then beta-blockade, then surgery ✓
• D Calcium channel blocker alone, then surgery

Explanation

In phaeochromocytoma, alpha-blockade (phenoxybenzamine or doxazosin) must be established before beta-blockade to prevent hypertensive crisis from unopposed alpha-adrenergic stimulation. Adding a beta-blocker before alpha-blockade can cause severe hypertension by blocking beta-2-mediated vasodilation. Surgery is performed only after adequate alpha and then beta blockade. Calcium channel blockers are used as adjuncts but not as sole agents.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.