Endocrine Abstracts

Introduction: Phaeochromocytoma in pregnancy is very rare and potentially dangerous situation for mother and foetus. Failure to diagnose this condition or suboptimal management can be disastrous for mother and/or foetus, because of raised catecholamine levels.

Case: A 22-year-old pregnant woman (8 weeks’ gestation) with hypertension and a suspected recurrence of phaeochromocytoma was referred to the Endocrinology Department in March 2014. The pregnancy was unplanned. In physical examination her height – 176 cm, weight – 74 kg, blood pressure and pulse were 156/90 mmHg and 92 beats/min respectively. Laboratory investigations: metanephrin 0.42 nmol/l (0–0.456), normetanephrin >16.38 nmol/l (0–0.1037), potassium 3.4 mmol/l (3.8–5.3), plasma renin activity (PRA) 16.81 ng/l (1.6–14.7), aldosterone (ALD) 633 ng/l (35–300), with normal ALD:PRA ratio, chromogranin A 361.18 μg/l (0–100). From her medical history it was already known that she underwent right adrenalectomy due to pheochromocytoma in March 2012. 6 months later increased blood preassure till 160/100 mmHg was observed. On abdominal CT scan (June 2013) – right adrenal gland removed, several ~1.1×1.0 cm lymph nodes are visible, left adrenal gland structural, without any additional masses in it. Metanephrin and normetanephrin tests indicated significantly elevated catecholamines levels. Unfortunately abdominal MRI (August 2013, September 2014) and MIBG scans (October 2013, February 2014) did not reveal possible source of catecholamines hyperproduction as well. Genetic testing results were negative. Hypertention during first trimester was treated with Labetalol 600mg/day, Metildopa 1000 mg per day, potassium chloride 1500 mg per day. Phenoxybenzamine hydrochloride was added later on and titrated till 100 mg per day in order to reach satisfactory blood pressure control. In September 2014 the patient had uncomplicated delivery of a healthy boy (weight – 2890 g, height – 47 cm, Apgar score 9–9) via Caesarean section. She is breast-feeding and continues Labetalol 900 mg per day for hypertension control. Further investigations are planned to identify localization of phaeochromocytoma.

Conclusion: This case illustrates that adequate medical management in the case of phaeochromocytoma predispose the successful pregnancy outcome.