This handout is for multiple endocrine neoplasia type 2a (men2a). Your care team identified this based on: positive germline ret mutation (proband or cascade-tested relative) (ata 2015).
Other reasons your team may use this plan: family history of men2 / mtc / pheochromocytoma (ata 2015); elevated basal/stimulated calcitonin or cea (ata 2015); medullary thyroid carcinoma or c-cell hyperplasia on fna / thyroid nodule (ata 2015).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| phenoxybenzamine | 10 mg BID, titrate q2–3 d to BP <130/80 + mild postural drop | PO | BID for 10–14 d preop | ATA 2015 / Endocrine Society 2014 — irreversible α-blockade must precede β; pheo excluded & treated before any MTC/parathyroid surgery |
| doxazosin | 1 mg daily → titrate to 8–16 mg/day | PO | daily | Selective α1 reversible alternative; preferred in pregnancy (ATA 2015) |
| propranolol | 20 mg TID | PO | TID | β ONLY after adequate α-blockade — never before (unopposed α → crisis) (ATA 2015) |
| phentolamine | 5 mg IV bolus, repeat q5–10 min | IV | PRN | Rapid IV α-blockade for intra/perioperative catecholamine crisis (ATA 2015) |
Plan: MEN2A sequenced management — pheo FIRST (α→β) → thyroidectomy by ATA risk + calcitonin → parathyroidectomy → advanced-MTC RET inhibitor → surveillance (ATA 2015)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Genetic counselling + cascade RET testing of first-degree relatives; lifelong endo/surgery/genetics follow-up; pre-conception counselling (pheo exclusion before pregnancy); patient education on component surveillance and return precautions (ATA 2015)
Guideline: 2015 revised ATA Medullary Thyroid Carcinoma Guidelines (Wells); 2021-2025 MEN2/RET updates (selpercatinib LIBRETTO-001, pralsetinib ARROW; NCCN Neuroendocrine 2025)