Endocrine Abstracts

Hypertension in pregnancy is common and is usually caused by preeclampsia. Catecholamine-producing tumours are very infrequent in pregnancy, but a high index of suspicion is needed to detect this condition with high maternal and foetal mortality.

We report a case of undiagnosed pheochromocytoma, complicated by multisystem failure.

A 32-year-old lady during her second pregnancy was referred to the obstetricians with hypertension at 26 weeks gestation. She was noted to have 1+ proteinuria and was diagnosed as pregnancy induced hypertension, treated with m-dopa. She also gave symptoms of headache and dizziness throughout her pregnancy. Her blood pressure fluctuated widely with occasional hypotensive episodes. Though pheochromocytoma was considered, urinary catecholamines were not done as she was already on M-Dopa. She had an elective caesarean section at 38 weeks gestation under spinal anaesthesia. Her section was complicated by post partum haemorrhage and shock. As her conscious level worsened a CT of her head was organised which was normal. During her stay in ITU, she had wide fluctuations in her blood pressure. She went into pulmonary oedema and acute renal failure and was haemofiltered for a few days. She gradually improved and was started on labetalol when pheochromocytoma was suspected.

A 24 h urinary collection showed raised noradrenaline and dopamine levels. An MRI of the adrenals confirmed a 6 cm mass in her right adrenal gland. A MIBG scan showed a positive uptake at the adrenal mass. She was started on Phenoxybenzamine and later on beta blocker. She successfully underwent laparoscopic surgery to remove the mass, the histology confirmed the diagnosis.

Diagnosis of pheochromocytoma during pregnancy can be difficult as the clinical presentation can resemble pre-eclampsia. Biochemical confirmation should be done before M-Dopa is given, as false positive results can occur. Delivery should be through caesarean section because labour and vaginal delivery can cause a crisis.