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?
- A)Begin desmopressin and free water restriction
- B)Start hydrocortisone only
- C)Start propranolol first, then phenoxybenzamine
- D)Start spironolactone only
- E)Start phenoxybenzamine first, then add a beta blocker if neededGABARITO
Explicação
Patients with pheochromocytoma should receive alpha blockade before beta blockade. Initial alpha blockade prevents unopposed alpha adrenergic vasoconstriction, which can precipitate severe hypertension if a beta blocker is given first. Phenoxybenzamine is the ... Ver explicação completa e trilha adaptativa →