Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment for pheochromocytoma?

1. Beta-blockers

2. Surgical resection

3. Phenoxybenzamine

4. Corticosteroids

The correct answer is: Phenoxybenzamine

The first-line treatment for pheochromocytoma is phenoxybenzamine, which is an irreversible non-selective alpha-adrenergic antagonist. This medication is crucial for managing the symptoms of hypertension that are characteristic of pheochromocytoma, a tumor of the adrenal gland that secretes catecholamines, leading to intermittent or sustained high blood pressure. Phenoxybenzamine helps to block the effects of excess catecholamines by preventing them from activating alpha-adrenergic receptors, which contributes to both blood pressure control and symptom relief. It is typically administered before any surgical intervention, as preoperative preparation with this drug helps to stabilize the patient and reduce the risk of hypertensive crises that can occur during surgery or due to catecholamine release. Surgical resection is indeed the definitive treatment for pheochromocytoma; however, it is usually preceded by the use of phenoxybenzamine to ensure optimal blood pressure control and minimize perioperative risks. Other options, such as beta-blockers or corticosteroids, are not appropriate as first-line treatments for this condition. Beta-blockers, for example, should not be started until adequate alpha-adrenergic blockade has been achieved to avoid exacerbating hypertension.