Systematic review of phaeochromocytoma in pregnancy

Biggar, Magdalena; Lennard, T. W. J.

doi:10.1002/bjs.8976

Cited by 107 publications

(129 citation statements)

References 83 publications

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“…To consider a pheochromocytoma in this situation is a particular diagnostic challenge, as preeclampsia is a much more common cause of hypertension in this patient group (20,21).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Life-threatening events in patients with pheochromocytoma

Riester

Weismann

Quinkler

et al. 2015

European Journal of Endocrinology

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Objective: Pheochromocytomas are rare chromaffin cell-derived tumors causing paroxysmal episodes of headache, palpitation, sweating and hypertension. Life-threatening complications have been described in case reports and small series. Systematic analyses are not available. We took an opportunity of a large series to make a survey. Design and methods: We analyzed records of patients diagnosed with pheochromocytomas in three geographically spread German referral centers between 2003 and 2012 (nZ135). Results: Eleven percent of the patients (ten women, five men) required in-hospital treatment on intensive care units (ICUs) due to complications caused by unsuspected pheochromocytomas. The main reasons for ICU admission were acute catecholamine induced Tako-Tsubo cardiomyopathy (nZ4), myocardial infarction (nZ2), acute pulmonary edema (nZ2), cerebrovascular stroke (nZ2), ischemic ileus (nZ1), acute renal failure (nZ2), and multi organ failure (nZ1). One patient required extracorporeal membrane oxygenation due to a hypertensive crisis with lung edema occurring during delivery (nZ1). Two patients died of refractory shock and pheochromocytomas were found postmortem. Two patients were treated by emergency surgery. Compared to pheochromocytoma patients without life-threatening events (nZ120), patients with complications had a significant larger maximal tumor diameter (7.0 vs 4.5 cm, P!0.01), higher levels of catecholamines (20-vs ninefold upper limit of normal, P!0.01), and tended to be younger (42 vs 51 years, PZ0.05). Conclusion: Although pheochromocytomas are rare, they are likely to be associated with a life-threatening situation. Clinicians have to be aware of these situations and perform a timely diagnosis.

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“…To consider a pheochromocytoma in this situation is a particular diagnostic challenge, as preeclampsia is a much more common cause of hypertension in this patient group (20,21).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Life-threatening events in patients with pheochromocytoma

Riester

Weismann

Quinkler

et al. 2015

European Journal of Endocrinology

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“…Due to these advances in pretreatment of patients with α-blockade and technical progress in surgical and anesthesiological techniques, over the last past decades, maternal and fetal prognosis have already considerably improved (3,5,6,7,9).…”

Section: Resultsmentioning

confidence: 99%

“…Also in a series of patients diagnosed with pheochromocytoma during pregnancy, a disease-causing mutation was found in around 30% of patients (5). Based on the relatively young age of the patients with pheochromocytoma during pregnancy, the changes of finding a genetic defect might be even higher.…”

Section: Diagnosismentioning

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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“…Pheochromocytoma associated with pregnancy is not common, without specific symptoms, but life‐threatening, increasing both maternal and fetal mortality up to 50% 1. Caesarean section has been known to induce pheochromocytoma crisis 2.…”

Section: Introductionmentioning

confidence: 99%

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

et al. 2016

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Pheochromocytoma associated with pregnancy is not common. Caesarean section may induce pheochromocytoma crisis, resulting in a lethal condition. The clinical picture of pheochromocytoma crisis is extremely variable. In this report, we describe a case of severe pheochromocytoma crisis induced by caesarean section presenting with hyperpyrexia, haemodynamic collapse, muscle weakness, heart failure, and acute kidney injury. Furthermore, we report that the muscle weakness was a manifestation of rhabdomyolysis, resulting from the pheochromocytoma crisis. Standard medical therapy failed to halt the patient's rapidly deteriorating condition. Continuous renal replacement therapy removed catecholamines from the circulation, resulting in improvement of haemodynamics and abrogation of rhabdomyolysis.

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Systematic review of phaeochromocytoma in pregnancy

Cited by 107 publications

References 83 publications

Life-threatening events in patients with pheochromocytoma

Life-threatening events in patients with pheochromocytoma

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

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

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