What is the first-line treatment for pheochromocytoma?

The first-line treatment for pheochromocytoma is alpha-antagonists. Pheochromocytomas are tumors of the adrenal medulla that secrete catecholamines, primarily epinephrine and norepinephrine, leading to symptoms such as hypertension, palpitations, and anxiety. The goal of treatment is to control hypertension and mitigate the effects of catecholamines before any surgical intervention.

Alpha-antagonists work by blocking the alpha-adrenergic receptors, which are responsible for the vasoconstrictive effects of norepinephrine. By antagonizing these receptors, alpha-blockers help to lower blood pressure and reduce other symptoms associated with excess catecholamine levels. Start therapy with an alpha-antagonist to ensure that hypertension is controlled.

It is crucial to manage the patient's blood pressure appropriately before considering the addition of beta-antagonists. If a beta-blocker is given before adequate alpha-adrenergic blockade, it can cause unopposed stimulation of alpha receptors by circulating catecholamines, potentially leading to a hypertensive crisis. Therefore, the use of alpha-antagonists as the first step in therapy is clinically essential for safely managing pheochromocytoma.