American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is the first management step for pheochromocytoma in MEN 2A?

1. Surgical removal

2. Medication to control hypertension

3. Observation

4. Biopsy

The correct answer is: Medication to control hypertension

The initial management step for pheochromocytoma in patients with Multiple Endocrine Neoplasia type 2A (MEN 2A) is to implement medication to control hypertension. Pheochromocytomas are neuroendocrine tumors that produce catecholamines, leading to episodes of hypertension, palpitations, and other symptoms. It is critical to stabilize the patient's blood pressure and manage the symptoms before surgical intervention can take place. Alpha-adrenergic blockers, such as phenoxybenzamine, are typically used to control hypertensive episodes. This preoperative management is essential to minimize the risk of intraoperative complications, such as hypertensive crises, during the eventual surgical removal of the tumor. Once the patient is adequately controlled on medications and blood pressure is stable, the surgical removal of the tumor can be performed as a definitive treatment. Therefore, addressing hypertension first is a crucial part of the management strategy in patients with pheochromocytomas, especially in those with underlying conditions such as MEN 2A.