Rosh Internal Medicine Boost Practice Exam

In a patient with a known adrenal mass and elevated catecholamines, what is the appropriate preoperative medication?

1. Enalapril

2. Losartan

3. Pheynoxybenzamine

4. Propranolol

The correct answer is: Pheynoxybenzamine

In the context of a patient with a known adrenal mass that is producing elevated catecholamines, the primary concern is the potential for catecholamine-induced hypertensive crises. These can occur due to the excess catecholamines released, particularly during surgical manipulation of the mass. Phenoxybenzamine is an irreversible alpha-adrenergic blocker that is essential for managing the symptoms associated with pheochromocytomas, tumors that arise from chromaffin cells in the adrenal glands. By blocking the alpha receptors, phenoxybenzamine effectively reduces vasoconstriction induced by circulating catecholamines, thereby controlling blood pressure and preventing hypertensive crises during surgery. This preoperative preparation is crucial because it allows for stable hemodynamics in patients who are at risk of severe hypertension due to the surgical stress response or the handling of the adrenal mass. Administering phenoxybenzamine several days prior to surgery helps to ensure that the patient is hemodynamically stable during the operative procedure, reducing the risk of intraoperative complications related to hypertension. Other medications listed, while they may have uses in managing hypertension or heart conditions, do not specifically address the need for alpha blockade in the context of elevated catecholamines from an adrenal mass. Therefore, employing