A 34-year-old woman presents with episodic severe headache, diaphoresis, and palpitations. 24-hour urine metanephrines are elevated 4-fold. CT shows a 4 cm right adrenal mass. She is scheduled for adrenalectomy. Which is the CORRECT sequence of preoperative pharmacological preparation?
- A Beta-blocker first for 7 days, then add alpha-blocker
- B Calcium channel blocker alone for 14 days
- C Alpha-blocker first for 10–14 days, then add beta-blocker if tachycardia persists ✓
- D Simultaneous alpha- and beta-blocker from day 1
Correct answer: C. Alpha-blocker first for 10–14 days, then add beta-blocker if tachycardia persists
Explanation
Alpha-blockade (phenoxybenzamine or doxazosin) must be established FIRST for at least 10–14 days before surgery to allow volume expansion and prevent hypertensive crises during tumour manipulation. Adding a beta-blocker before adequate alpha-blockade causes unopposed alpha-stimulation leading to paradoxical severe hypertension. Beta-blockers are added only after alpha-blockade if reflex tachycardia remains problematic. Calcium channel blockers are an alternative in special situations but not first-line per current Endocrine Society guidelines.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.