Which statement describes the standard preoperative management for pheochromocytoma?

• A. Beta-blocker therapy alone is sufficient preoperatively
• B. Non-selective alpha-blocker followed by beta-blocker or calcium channel blocker to control hypertension
• C. ACE inhibitors alone
• D. Calcium channel blocker therapy alone

Answer: (B)

Pheochromocytoma can unleash a surge of catecholamines that cause severe hypertension and tachycardia, especially during tumor manipulation. The essential preoperative step is to block alpha-adrenergic effects first, which reduces vascular resistance and allows the plasma volume to expand, helping prevent an intraoperative hypertensive crisis. A non-selective alpha-blocker is started preoperatively, and once adequate alpha blockade is established, a beta-blocker can be added to control heart rate, or a calcium channel blocker can be used as an alternative or adjunct for blood pressure control. Starting beta-blockade alone is problematic because it leaves unopposed alpha stimulation, risking dangerous hypertension. ACE inhibitors or calcium channel blockers alone don’t address the adrenergic vasoconstriction, so they’re not sufficient by themselves.