Before pheochromocytoma resection, which preoperative management is essential?

• A. Beta-blockade alone
• B. Alpha-adrenergic blockade (e.g., phenoxybenzamine) before beta-blockade and surgery
• C. Calcium channel blocker alone
• D. No preoperative management is necessary

Answer: (B)

Pheochromocytoma releases large amounts of catecholamines that cause strong vasoconstriction and rapid heart rate. The crucial step before removing the tumor is to blunt that vasoconstrictive and pressor response by starting alpha-adrenergic blockade well before surgery. This lowers blood pressure, reduces the risk of a dangerous hypertensive spike during tumor manipulation, and helps the body adjust by expanding circulating volume.

Beta-blockade should be added only after adequate alpha blockade. If a beta-blocker is given first, unopposed alpha-adrenergic activity can drive a life-threatening surge in blood pressure during tumor handling. Calcium channel blockers alone don’t prevent the alpha-driven vasoconstriction, so they don’t provide the full protective effect needed preoperatively. No preoperative management would leave the patient at high risk for intraoperative and perioperative complications.