Pheochromocytoma in Pregnancy

Abstract

Pheochromocytoma is a rare disease that may occur during pregnancy. Only a few hundred cases have been published in the literature. Manifestations include hypertension with various clinical presentations, possibly resembling those of pregnancy-induced hypertension, or pre-eclamptic toxemia. Differentiation of these conditions is not always feasible, thus creating a serious risk, because fetal and maternal morbidity and mortality are far higher with pheochromocytoma. Biochemical measurements of catecholamines and their metabolites are apparently a convenient way to establish diagnosis during pregnancy, inasmuch as interpretation of radiological evaluation is complicated by the gravid uterus, and might even be potentially dangerous due to the use of ionizing radiation. More sophisticated methods for evaluation are not always practical during pregnancy. Medical treatment aims at controlling symptoms, mandating the use of alpha- and beta-receptors blockade medication. Surgical intervention is the only possible curative method available, but the critical issue is probably to identify the exact timing during the course of pregnancy for such intervention, or the ability to control symptoms until delivery. Although malignant transformation of pheochromocytoma have been reported, it is extremely uncommon. The overall prognosis is mainly affected by early diagnosis, and multidisciplinarian management.

The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature

“…However, it should be noted that some patients with pheochromocytoma are normotensive in pregnancy, making the diagnosis more challenging in these cases [14]. …”

Un cas de phéochromocytome découvert au cours d’une grossesse gémellaire: un diagnostic à ne pas méconnaitre et revue de littérature

“…Après 24 SA, l´intervention est retardée du fait de l´utérus gravide. On attend (au mieux) la maturité pulmonaire pour faire une césarienne par voie médiane, suivie d´une exérèse tumorale au cours de la même anesthésie générale [ 8 ].…”

Management of paroxysmal hypertension due to incidental pheochromocytoma in pregnancy

“…[1314] It is believed that vaginal delivery stimulates the massive release of catecholamines from the tumor. [815] If vaginal delivery is attempted; adequate analgesia and proper treatment is required to manage the extreme hemodynamic fluctuations.…”