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Answer 3
  1. Sodium nitroprusside. The Figure shows a right adrenal mass with high signal intensity suspicious for pheochromocytoma. In this case, percutaneous biopsy of the lesion incited a hypertensive crisis. The preferred treatment for a hypertensive crisis from catecholamine release is intravenous sodium nitroprusside. Phenoxybenzamine, an oral nonselective α-antagonist, is used preoperatively in patients undergoing surgical resection of pheochromocytoma. Intravenous metoprolol may block the vasodilating ß-adrenergic receptors on peripheral vasculature and can worsen a hypertensive crisis. Metyrosine inhibits catecholamine synthesis but is not used in the acute setting. Nifedipine is an oral calcium channel blocker. Intravenous antihypertensive medications with a rapid onset of action should be used during a hypertensive emergency. Nicardipine is an intravenous calcium channel blocker that can be used during hypertensive crisis if sodium nitroprusside is not available. Of note, biochemical testing for pheochromocytoma should be performed on all suspicious adrenal masses before planned procedures.

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