A 55-year-old man with MEN2A is found to have medullary thyroid carcinoma on calcitonin screening. Surgery is planned. What is the CORRECT sequence of management?

• A Total thyroidectomy first, then screen for pheochromocytoma
• B Parathyroid adenoma resection first, then thyroidectomy
• C Concurrent thyroidectomy and adrenalectomy to reduce number of surgeries
• D Screen for pheochromocytoma first; adrenalectomy if present, then thyroidectomy ✓

Explanation

In MEN2A, pheochromocytoma must be excluded before any elective surgery because intraoperative catecholamine surge from an unsuspected pheo can cause fatal hypertensive crisis. Biochemical screening (plasma or urinary catecholamines/metanephrines) is mandatory; if pheochromocytoma is found, adrenalectomy is performed first under alpha-blockade, followed by thyroidectomy. This is a well-established management principle in MEN2 syndromes.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.