Adrenal Disorders USMLE Step 1 Practice Question
A 45-year-old woman with a CT-confirmed adrenal pheochromocytoma (8 cm mass with high attenuation) is scheduled for surgical resection. Currently BP 128/82 mmHg, HR 88 bpm, but history documents multiple hypertensive episodes (BP 180/110 mmHg). Plasma free metanephrines are markedly elevated at 850 pg/mL (normal <90). She reports palpitations and diaphoresis during episodes but denies chest pain. No prior alpha-blocker use. Which pharmacologic strategy optimally prepares her for surgery?
Answer choices
- ABegin desmopressin and free water restriction
- BStart hydrocortisone only
- CStart propranolol first, then phenoxybenzamine
- DStart spironolactone only
- EStart phenoxybenzamine first, then add a beta blocker if neededCorrect answer
- FStart labetalol monotherapy for combined alpha and beta blockade
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