Endocrine Abstracts

Introduction: We submit a rare presentation of pheaochromocytoma in pregnanacy, diagnosed just before delivery, posing complex management difficulties.

Case presentation

A 24-year-old primipara had headache, hypertension and visual disturbance but without any palpitations or diaphoresis. Her headache was persistent during pregnancy. Investigations at 39 weeks of gestation showed normal plasma Normetadrenaline at 885.0 (120–1180) but raised Metadrenaline raised at 1849 (80–510) leading onto a diagnosis of pheochromocytoma. There was an initial diagnostic dilemma, if the raised catacholamines are due to stress with pregnanacy. However ultrasound abdomen showed left adrenal enlargement. She was started on phenoxybenzamine and the blood pressure was controlled. Labour was successfully managed with adequate α blockade and a healthy baby was delivered by Caessarean section at 40 weeks of gestation. After delivery she was started on Bisoprolol along with increasing dose of phenoxybenzamine. Left adrenal pheochromocytoma was confirmed by CT Abdomen showing a 9×6 mm left adrenal adenoma which was confirmed by MIBG Scan. Laparoscopic left adrenalectomy was planned with controlled α and β blockade.

Discussion: Hypertension is a common problem in pregnancy that can result in significant maternal and foetal morbidity and mortality. The common causes include pre -eclampsia, gestational hypertension and essential hypertension. Although pheochromocytoma is a rare cause of hypertension in pregnancy (0.007% of all pregnancies), it can lead to potentially life-threatening cardiovascular complications for the mother and increased foetal mortality if left undiagnosed and untreated. In pregnancy, depending on the gestation at which diagnosis is made, the optimal timing for surgery is during the late first or early second trimester. When the pregnancy is more advanced, medical management followed by combined caesarean section and tumour resection closer to term is preferred.