What is the first line treatment for pheochromocytoma?

The first-line treatment for pheochromocytoma involves alpha blockade with phenoxybenzamine followed by surgical intervention, specifically adrenalectomy. Pheochromocytomas are tumors that produce catecholamines like epinephrine and norepinephrine, leading to symptoms such as hypertension, tachycardia, and other adrenergic effects.

Before surgery, it is crucial to adequately manage the symptoms caused by excessive catecholamines to prevent intraoperative complications. Phenoxybenzamine is a non-selective irreversible alpha-adrenergic antagonist that effectively manages hypertension and other symptoms by blocking the effects of catecholamines, allowing for a more stable hemodynamic status during surgery. After achieving effective alpha blockade, an adrenalectomy can be performed to remove the tumor.

Surgical resection alone, while necessary, is not appropriate as a first-line treatment without prior pharmacologic management to address the hypertensive crisis that can occur during surgery. Chemotherapy is generally reserved for metastatic or unresectable cases, and radiation therapy does not target the tumor directly as a primary treatment modality. Thus, the combination of alpha blockade with phenoxybenzamine followed by surgical resection is the optimal approach for managing pheochromocytoma.