A 40-year-old woman presents with headache, palpitations, and episodic hypertension. 24-hour urine metanephrines are elevated. CT abdomen shows a 4 cm right adrenal mass. Prior to surgical resection, which medication must be given FIRST?
- A Beta-blocker (propranolol)
- B Alpha-blocker (phenoxybenzamine) ✓
- C Calcium channel blocker (amlodipine)
- D ACE inhibitor (enalapril)
Correct answer: B. Alpha-blocker (phenoxybenzamine)
Explanation
Preoperative preparation for pheochromocytoma requires alpha-adrenergic blockade first (phenoxybenzamine, a non-competitive irreversible alpha-blocker, or doxazosin/prazosin as competitive alternatives) to prevent hypertensive crisis during surgical manipulation. Beta-blockers must NEVER be given first; unopposed alpha-stimulation would cause severe hypertensive crisis. Beta-blockers are added ONLY after adequate alpha-blockade is established to control reflex tachycardia. Calcium channel blockers may be added as adjuncts but do not replace alpha-blockade.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.