A 52-year-old man presents with acute onset severe headache, profuse diaphoresis, palpitations, and blood pressure of 185/110 mmHg. His symptoms are episodic, lasting 30-60 minutes. Plasma metanephrines are elevated. An abdominal CT reveals a 3.2 cm right adrenal mass. Which of the following is the most appropriate next step in management?
- A)Initiate alpha-blockade followed by beta-blockade, then surgical resectionGABARITO
- B)Perform adrenal biopsy for histologic confirmation
- C)Start hydralazine and schedule a repeat CT in 3 months
- D)Immediate surgical resection without pharmacologic preparation
- E)Begin beta-blockade alone followed by surgery
Explicação
This patient has pheochromocytoma with classic catecholamine-induced hypertensive crisis. Before surgery, alpha-blockade (phenoxybenzamine) must be given first to prevent severe hypertensive episodes intraoperatively. Beta-blockade is then added (only after al... Ver explicação completa e trilha adaptativa →