Adrenal Diseases During Pregnancy: Pathophysiology, Diagnosis and Management Strategies

Kamoun, Mahdi; Mnif, Mouna; Charfi, Nadia; Kacem, F. Hadj; Naceur, B. Ben; Mnif, F.; Dammak, M.; Rekik, N.; Abid, M.

doi:10.1097/maj.0b013e31828aaeee

Cited by 68 publications

(80 citation statements)

References 68 publications

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“…Catecholamine metabolism is generally unaltered during healthy pregnancy, and even in patients with preeclampsia, plasma catecholamine levels are only slightly increased (9). Therefore, in pregnant patients, similar to non-pregnant patients, the most reliable test to confirm or exclude pheochromocytoma is analysis of plasma and/ or 24-h urine (nor)metanephrine concentrations (11,16). Slightly increased results may be false positive due to limitations of the test or problems with collection of the materials.…”

Section: Diagnosismentioning

confidence: 99%

“…In addition, accompanying symptoms can help to distinguish different forms of hypertension. Hypertension accompanied by not only headaches, palpitations and sweating but also hyperglycemia or cardiomyopathy is suggestive of pheochromocytoma, whereas hypertension accompanied by proteinuria and edema is more suggestive for pregnancy-related hypertension (10,11). Finally, specific phenotypical features such as café-au-lait spots, freckles and fibromas might suggest a syndrome-based pheochromocytoma (8,12).…”

Section: Symptomsmentioning

confidence: 99%

“…Symptoms may worsen with advancing pregnancy due to an increased pressure on the tumor by the increasing abdominal distension, fetal movements and uterine contractions (9,11). Moreover, estrogens have been suggested to act as a growth factor for adrenal tumors (9,11,13,14).…”

Section: Symptomsmentioning

confidence: 99%

“…Slightly increased results may be false positive due to limitations of the test or problems with collection of the materials. Results must also be interpreted with caution when patients are already using methyldopa or labetalol as these medications can lead to false-positive results in assays using liquid chromatography with fluorescence detection (7,11). Provocation tests, such as the clonidine suppression test, should be avoided because of low sensitivity and potential serious side effects (9,11).…”

Section: Diagnosismentioning

confidence: 99%

“…These drugs include for example corticosteroids (commonly prescribed to enhance fetal lung maturation in threatening preterm labor), opioids such as morphine and pethidine, anti-emetics such as metoclopramide and anesthetics such as thiopental, ketamine and ephedrine and muscle relaxants such as mivacurium (11,26).…”

Section: Pretreatmentmentioning

confidence: 99%

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ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

Weerd

Noord

Loeve³

et al. 2017

European Journal of Endocrinology

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Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.

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Section: Diagnosismentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Pretreatmentmentioning

confidence: 99%

See 3 more Smart Citations

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

Weerd

Noord

Loeve³

et al. 2017

European Journal of Endocrinology

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Liver and Endocrine Diseases in Pregnancy

Heneghan

Williamson

2018

Dewhurst's Textbook of Obstetrics &Amp; Gynaecology

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Intrapartum adrenalectomy for pheochromocytoma presenting in pregnancy: A case report

Naseef

2023

Clinical Case Reports

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Pheochromocytoma is one of the rare causes of hypertension in pregnancy, occurring in one in every 50,000 pregnancies. The aim of this case report is to describe an atypical presentation of pheochromocytoma at 35 weeks gestation, where it presented with right flank pain and seizures, its preoperative medical optimization, and intrapartum concurrent surgical management. It also discusses various clinical presentations of pheochromocytoma in pregnancy, appropriate laboratory and radiological investigations, and different modalities of treatment. It is important to consider the possibility of the diagnosis of pheochromocytoma when considering the different causes of high blood pressure in a term pregnancy. Prompt antenatal diagnosis and timely management are critical to reducing maternal and perinatal morbidity and mortality rates.

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Adrenal Diseases During Pregnancy: Pathophysiology, Diagnosis and Management Strategies

Cited by 68 publications

References 68 publications

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

Liver and Endocrine Diseases in Pregnancy

Intrapartum adrenalectomy for pheochromocytoma presenting in pregnancy: A case report

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