What is the first-line treatment for pheochromocytoma?

The first-line treatment for pheochromocytoma is an alpha-blocker. Pheochromocytoma is a tumor of the adrenal gland that secretes excess catecholamines, such as epinephrine and norepinephrine, which can lead to episodes of hypertension, palpitations, and other symptoms associated with catecholamine excess. The primary goal in managing pheochromocytoma is to control these symptoms effectively before surgical intervention.

Alpha-blockers work by antagonizing the effects of norepinephrine at the alpha-adrenergic receptors, which helps to lower blood pressure and mitigate the hypertensive episodes that patients experience. Starting with an alpha-blocker is essential because uncontrolled hypertension can lead to severe cardiovascular complications during surgery.

The timing of initiating beta-blockers is critical; using them before adequately controlling alpha receptor stimulation could lead to unopposed alpha-adrenergic receptor activity, potentially worsening hypertension. Therefore, alpha-blockade is prioritized to stabilize the patient before considering additional medication options or surgical removal of the tumor.

In contrast, calcium channel blockers and vasodilators can be used as adjunctive therapies for managing hypertension in specific scenarios, but they are not considered first-line treatments.