Pheochromocytoma and pregnancy: A case report and review

Abstract

Pheochromocytoma is a catecholamine-producing adrenal tumor, being a rare cause of hypertension in pregnancy. It's prevalence in hypertensive patients is 0.2%, and 0.002% of pregnancies. We follow hypertensive pregnant 24 year old on her third pregnancy, admitted to 33 weeks with hypertensive emergency cesarean section indicated by fetal distress evolving with acute pulmonary edema in the post-partum period. Indicated laparoscopy after 13 days for acute abdominal pain, with no significant finding. In the postoperative, due a severe and resistant hypertension, suspected of pheochromocytoma and confirmed by biochemical tests and imaging. Performed unilateral adrenelectomia with cure of hypertension. The pathology and immunohistochemistry confirmed the diagnosis. We conclude that atypical cases of hypertension in pregnancy should be investigated early and differentiated pre-eclampsia. Despite the low prevalence, pheochromocytoma in pregnancy increases fetal maternal morbidity and mortality and the early recognition and treatment drastically change their outcome.

Hormone‐secreting adrenal tumours cause severe hypertension and high rates of poor pregnancy outcome; a UK Obstetric Surveillance System study with case control comparisons

“…The most common presenting features in the UKOSS phaeochromocytoma cases were palpitations (40%, 95% CI 12.2–73.7), headaches (20%, 95% CI 2.5–55.6) and hypertension (20%, 95% CI 2.5–55.6). The previously reported cases had similar findings; palpitations affected 29.3% (95% CI 21.4–38.1) and headache affected 34.1% (95% CI 25.8–43.2). However, although the most noticeable feature in the previously reported cases was hypertension (73.9%, 95% CI 65.3–81.5), blood pressure control varied in the UKOSS cohort of women with phaeochromocytoma in pregnancy.…”

“…reviewed all articles, and individual cases common to more than one report were identified and excluded to ensure no individual case was compared twice. The majority of phaeochromocytoma cases were captured in two systematic reviews as well as in three additional case reports, providing a total of 123 additional phaeochromocytomas for comparison. For primary aldosteronism there was one systematic review as well as 15 individual cases, resulting in 34 cases for comparison.…”

Laparoscopic approach to pheochromocytoma in pregnancy: case report

“…These signs and symptoms include hypertension (98% of cases), orthostatic hypotension, palpitations, headaches, sweating, anxiety attacks, facial flushing, and chest pain ( 5 , 6 ). However, in pregnant women, the disease can be mistaken for other causes of hypertension, especially specific hypertensive disorders of pregnancy such as pre-eclampsia ( 3 ). In the current case, preeclampsia in the previous pregnancy may have been the first manifestation of PCC, but this hypothesis was not investigated at the time.…”

“…Although extraordinarily rare during pregnancy with a reported incidence less than 0.2 per 10,000 pregnancies, PCC should be considered when severe hypertension occurs before 20 weeks gestation or when hypertension is associated with disease symptoms such as headaches, palpitations, and diaphoresis ( 2 ). PCC in gestation, when untreated, raises maternal and fetal mortality to up to 50% ( 3 , 4 ). However, early diagnosis and appropriate treatment reduce maternal mortality to less than 5% and fetal mortality to below 15% ( 3 , 5 ).…”

“…PCC in gestation, when untreated, raises maternal and fetal mortality to up to 50% ( 3 , 4 ). However, early diagnosis and appropriate treatment reduce maternal mortality to less than 5% and fetal mortality to below 15% ( 3 , 5 ). The diagnosis can be established by detecting elevated levels of catecholamines and their metabolites in plasma or urine.…”