A patient presents with a blood pressure of 210/110 and headache; what is the first treatment step for suspected pheochromocytoma?

In the case of suspected pheochromocytoma, the appropriate first step in treatment is the use of alpha blockers. Pheochromocytoma is a tumor of the adrenal gland that secretes excessive catecholamines, leading to episodes of severe hypertension and other symptoms such as headaches.

Alpha-blockers work by inhibiting the effects of catecholamines on alpha-adrenergic receptors, which effectively reduces peripheral vascular resistance and lowers blood pressure. This approach addresses the primary issue of hypertension caused by excessive catecholamine release. Starting treatment with alpha-blockers also helps to prevent possible complications associated with unopposed alpha-adrenergic stimulation, such as hypertensive crises.

Using beta-blockers is contraindicated as an initial treatment in suspected pheochromocytoma because they can lead to unopposed alpha-adrenergic receptor stimulation, worsening hypertension and the symptoms associated with the condition. Sodium nitroprusside can be utilized for acute hypertensive crises but does not address the underlying cause of the hypertension in pheochromocytoma. Calcium channel blockers might help with blood pressure control but are not the first-line treatment for a suspected pheochromocytoma, as they do not specifically target the underlying adrenergic overactivity