Endocrinology: phaeochromocytoma: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: phaeochromocytoma

Sample item

A 38-year-old man has paroxysms of headache, sweating and palpitations. His blood pressure is 190/110 mmHg, 24-hour urinary metanephrines are markedly raised, and CT shows a 4 cm right adrenal mass. How should he be prepared for surgery?

ASpironolactone for 4 weeks to control blood pressureBA beta-blocker first, then an alpha-blocker after a weekCAlpha-blockade for 7 to 14 days first, then a beta-blocker if tachycardicDImmediate adrenalectomy without preparation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Alpha-blockade for 7 to 14 days first, then a beta-blocker if tachycardic

Alpha-adrenergic blockade (phenoxybenzamine or doxazosin) is started first for 7 to 14 days to control blood pressure and allow volume re-expansion. A beta-blocker is added only afterwards for tachycardia. Starting a beta-blocker alone leaves unopposed alpha vasoconstriction by catecholamines and can precipitate a hypertensive crisis.

Option by option

A. Spironolactone for 4 weeks to control blood pressure
Spironolactone is used in primary hyperaldosteronism, not catecholamine excess.
B. A beta-blocker first, then an alpha-blocker after a week
A beta-blocker first removes vasodilating beta-2 effects and can cause a hypertensive crisis.
C. Alpha-blockade for 7 to 14 days first, then a beta-blocker if tachycardic (correct)
Alpha-blockade first, then beta-blockade, is the safe sequence before surgery.
D. Immediate adrenalectomy without preparation
Unprepared surgery risks catastrophic haemodynamic swings during tumour handling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Alpha-blockade for 7 to 14 days first, then a beta-blocker if tachycardic. Alpha-adrenergic blockade (phenoxybenzamine or doxazosin) is started first for 7 to 14 days to control blood pressure and allow volume re-expansion.

Why is "Spironolactone for 4 weeks to control blood pressure" not the answer?

Spironolactone is used in primary hyperaldosteronism, not catecholamine excess.

Why is "A beta-blocker first, then an alpha-blocker after a week" not the answer?

A beta-blocker first removes vasodilating beta-2 effects and can cause a hypertensive crisis.

Why is "Immediate adrenalectomy without preparation" not the answer?

Unprepared surgery risks catastrophic haemodynamic swings during tumour handling.

What concept does this question test?

It tests Endocrinology: phaeochromocytoma in General Medicine. A beta-blocker is added only afterwards for tachycardia. Starting a beta-blocker alone leaves unopposed alpha vasoconstriction by catecholamines and can precipitate a hypertensive crisis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: phaeochromocytoma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.