Review Question - QID 104389

In a patient with pheochromocytoma, NEVER give pure beta-blockade. This would result in unopposed alpha activity from circulating catecholamines and could result in malignant hypertension.

Pheochromocytomas are rare tumors that produce catecholamines. The most common site is the adrenal medulla. Remember the rule of 10's - 10% are malignant, bilateral, extra-adrenal, calcified, pediatric, or familial. Symptoms are relapsing and remitting, causing episodic hypertension, pallor, perspiration, diaphoresis, headaches, and tachycardia. Diagnosis centers on clinical symptoms in conjunction with urinary metanephrines or vanillylmandelic acid and plasma catecholamines. Also recall the association with MEN 2A/2B. A tumor should be localized with CT or MRI and treated with alpha blockade first with or without beta blockade (often propranolol) and finally surgical resection.

Illustration A depicts a pheochromocytoma on CT.

Incorrect Answers:
Answer 1: Use of an alpha blocker in conjunction with a beta blocker, like Propranolol, is also not contraindicated.
Answer 2: Nitrates, like nitroprusside, are not contraindicated.
Answers 4: Use of an agent with combined alpha and beta blockade, such as labetalol is not contraindicated.
Answers 5: Use of an ACE-inhibitor like lisinopril is not contraindicated.

Bullet Summary:
In a patient with a pheochromocytoma, avoid giving beta-blockers due to unopposed alpha activity which could lead to significantly elevated blood pressure.