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Phaeochromocytoma: why preparation is critical | CION Cancer Clinics
A phaeochromocytoma makes adrenaline, and handling it during surgery can release a surge that sends blood pressure to dangerous levels. Weeks of alpha-blocker tablets, extra salt and fluids, called blockade, prepare the body so the surge does no harm. This page explains what the preparation involves, why the order of the tablets matters, and what to do if an attack happens while you wait. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why does a phaeochromocytoma need preparation before surgery?
- What the weeks before the operation look like
- Which medicines are used, and what each one is for
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about preparing for phaeochromocytoma surgery
The short answer
Why does a phaeochromocytoma need preparation before surgery?
A phaeochromocytoma is an adrenal tumour that makes adrenaline and its close relatives. When the surgeon handles it, the tumour can release a flood of adrenaline into the blood, sending blood pressure and heart rate to dangerous levels within minutes. Weeks of tablets beforehand, called blockade, stop that surge from doing harm.
What blockade actually does
Adrenaline works by acting on tiny switches on blood vessels and the heart, called alpha and beta receptors. Alpha-blocker tablets sit on the alpha switches so that adrenaline cannot squeeze the blood vessels. Once those are covered, a beta-blocker may be added to steady the heart. With the switches covered, the surge during surgery still happens, but the body no longer over-reacts to it.
Why the order of the tablets matters
The beta-blocker is never started first. On its own it removes the heart's ability to cope while leaving the blood vessels free to clamp down, and blood pressure can rise sharply. Your endocrinologist starts the alpha-blocker, increases it step by step, and only then considers a beta-blocker if your pulse is fast. Do not add or change any of these tablets yourself.
"Blockade" on your notes means this preparation. It does not mean anything is being blocked inside the tumour.
!
One thing that cannot wait
While you are waiting for surgery, a sudden pounding headache with sweating, a racing heart, chest pain or a blood pressure reading far above your usual is an attack, not something to sleep off. Go to the nearest emergency department the same day and say you have a phaeochromocytoma. Do not take an extra beta-blocker tablet on your own to calm the heart, because without alpha-blockade it can make the pressure worse.
Not sure whether this applies to you?
Ask an oncologistThe pathway
What the weeks before the operation look like
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The diagnosis is confirmed
Blood or urine tests for metanephrines, the breakdown products of adrenaline, confirm the tumour is active. A scan shows where it is and whether there is more than one.
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The alpha-blocker is started
Usually phenoxybenzamine, doxazosin or prazosin. The dose is raised gradually over a couple of weeks or more, until your blood pressure sits in the range your endocrinologist has set, including when you stand up.
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Salt and fluids are increased
Adrenaline shrinks the amount of blood in your circulation. As the blockade opens the vessels up, you will be asked to drink freely and to take more salt than usual, so that there is enough blood to fill them. This feels odd to someone who has spent years cutting salt.
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A beta-blocker may be added
Only after the alpha-blocker is working, and only if your pulse is fast. Not everyone needs one.
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The pre-operative check
The anaesthetist checks your lying and standing blood pressure, pulse, sugar and kidney tests, and confirms you are ready. If you are not, the operation is moved, and that is the right call.
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Operation day
You take the tablets the team has told you to take that morning. An arterial line at the wrist tracks your pressure beat by beat, and the anaesthetist has fast-acting drugs ready for the surge.
The tablets
Which medicines are used, and what each one is for
Doses and timing are set by your endocrinologist and anaesthetist. This is to help you recognise the names on your prescription.
Alpha-blockers
The foundation of the preparation. Phenoxybenzamine, doxazosin or prazosin. They open the blood vessels so adrenaline cannot clamp them shut.
What you may notice
- Dizziness on standing, especially at first
- A blocked nose, tiredness
Beta-blockers
Propranolol, atenolol or metoprolol. Added only after alpha-blockade, and only if the heart is racing. They slow the pulse.
Never the first tablet, and never taken on your own initiative.Calcium channel blockers
Amlodipine or nifedipine. Sometimes used alongside, or instead, when alpha-blockers are not tolerated or the pressure needs more control.
Salt and fluids
Not a medicine, but part of the prescription. Extra salt and free drinking refill the circulation before surgery, which softens the fall in pressure once the tumour is out.
Tell the team if you have
- Heart failure or kidney disease
- Been told to restrict salt for another reason
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Commonly believed
Four things families tell us, and what is actually true
"The tumour is dangerous, so it should come out this week."
For this tumour, rushing is the danger. An unprepared operation is where the worst blood pressure crises happen. The weeks of tablets are not a delay in treatment; they are the first half of the treatment.
"His pressure is normal now, so the tablets are not needed."
Normal readings at rest are the tablets working, not the tumour giving up. The surge during surgery happens whatever the resting pressure was. The preparation continues until the tumour is out.
"She feels dizzy on the tablets, so we halved them."
Dizziness on standing is expected early on and is part of why extra salt and fluids are prescribed. Tell the endocrinologist rather than cutting the dose, because an under-prepared patient is exactly what the team is trying to avoid.
"A biopsy will tell us for sure before surgery."
A needle into a phaeochromocytoma can trigger the same adrenaline surge as surgery, without an anaesthetist ready for it. The diagnosis is made by hormone tests and scans, and confirmed by the laboratory after the whole gland is removed.
Being straight with you
What this page cannot tell you
This page cannot tell you which tablet you should be on, what dose, or how long your own preparation will take. Those depend on your blood pressure readings, your heart, your kidneys and how your body responds week by week, and they are set by your endocrinologist and anaesthetist.
Who this preparation does not apply to
Most adrenal tumours do not make adrenaline, and people having surgery for a cortisol- or aldosterone-producing tumour, or for a lump found by chance, do not need alpha-blockade. If you are unsure which kind of tumour you have, ask. The word "phaeochromocytoma" or a raised metanephrine result on your report is the sign that this page is about you.
Questions worth asking
Ask what blood pressure and pulse targets the team is aiming for, and whether you should be checking readings at home. Ask what to do if you miss a dose or cannot keep tablets down. Ask whether genetic testing is being arranged, because some of these tumours run in families and close relatives may need screening. And ask whether an anaesthetist who regularly manages this tumour will be present on the day.
Bring your home blood pressure diary to every visit. It is the single most useful thing you can hand the team.Questions we are asked
Common questions about preparing for phaeochromocytoma surgery
How long does the preparation take?
Usually a few weeks, sometimes longer if the dose has to be raised slowly or the blood pressure is hard to settle. The team does not fix the date of surgery until your readings, lying and standing, are where they want them. Ask what targets they are working to, so you can see the progress yourself.
Why am I being told to eat more salt?
Because the tumour has been keeping your blood vessels tightly squeezed, and there is less fluid in your circulation than there should be. As the alpha-blocker opens the vessels, extra salt and water fill them up. Without that, your pressure can drop sharply once the tumour is removed.
What happens if surgery is done without blockade?
Handling the tumour releases adrenaline, and without the tablets the heart and vessels react in full. That can mean a blood pressure crisis, a dangerous heart rhythm or a stroke on the table, and a collapse in pressure once the tumour is out. This is why experienced teams will not operate on an unprepared patient.
I feel dizzy and my nose is blocked. Is that normal?
Both are common side effects of alpha-blockers, especially in the first days and whenever the dose goes up. Stand up slowly, drink well and keep taking the tablets. Tell your endocrinologist at the next visit, or sooner if you faint, so the dose and the fluids can be adjusted rather than the tablets abandoned.
Can I keep taking my usual blood pressure tablets?
Only the ones your endocrinologist has kept on the list. Some are continued, some are swapped, and a beta-blocker on its own is stopped or moved to after the alpha-blocker. Take your full current list, including anything bought over the counter, to the first appointment and let the team decide.
Will I need the tablets after the tumour is out?
Usually not for long. Once the source of the adrenaline is gone, the alpha-blocker is no longer needed and is stopped by the team, often before you go home. Some people still need ordinary blood pressure tablets if their pressure was high for other reasons. Your follow-up visits sort that out.
Should my family be tested?
Possibly. A meaningful share of these tumours are linked to an inherited gene change, and genetic testing is now offered to most people with a phaeochromocytoma. If a change is found, close relatives can be tested and screened early. Ask your endocrinologist whether testing has been arranged.
Is this covered by Aarogyasri or insurance?
The operation often is, when it is part of an approved plan. Aarogyasri, CGHS, ECHS and EHS are accepted and most cashless insurers are empanelled. The preparation tablets are usually an outpatient cost. Call the helpline with your card details and we will check what your scheme covers.
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Sources
- NHS — Phaeochromocytoma
- National Cancer Institute — Pheochromocytoma and Paraganglioma Treatment (PDQ) - Patient Version
- Cancer.Net (ASCO) — Pheochromocytoma and Paraganglioma
- Cancer Research UK — Phaeochromocytoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
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