What is the first-line therapy for pheochromocytoma prior to surgery?

The first-line therapy for pheochromocytoma prior to surgery is alpha-adrenergic blockade. Pheochromocytoma is a tumor that secretes catecholamines (such as epinephrine and norepinephrine), leading to episodic hypertensive crises and other sympathetic symptoms.

Alpha-adrenergic blockade is crucial because it addresses the hypertension and other vasoconstrictive effects caused by excess catecholamines. By initiating treatment with an alpha-blocker, you can control the blood pressure effectively, which reduces the risk of intraoperative complications, such as severe hypertension, during surgery.

Following adequate alpha-adrenergic blockade, a beta-adrenergic blocker may be introduced, but only after controlling blood pressure with the alpha-blocker, as beta-blockade alone could lead to unopposed alpha activity and worsen hypertension.

Other treatment options listed, such as sodium-glucose cotransporter inhibitors and corticosteroids, are not relevant for pheochromocytoma management prior to surgery. Sodium-glucose cotransporter inhibitors are primarily used in diabetes management, while corticosteroids are used in conditions related to adrenal insufficiency or inflammatory states, neither of which directly addresses the symptomatic hypertension associated with pheochromocytoma.