Endocrine Abstracts

Introduction: Pheochromocytoma is extremely rare in pregnancy and occurs 1 in 54000 pregnancies. If undiagnosed, Maternal and fetal mortality amounts to 40–50%. Early detection and prompt treatment decreases the maternal and fetal mortality to <5% and <15% respectively. There are multiple and complex issues in managing this condition in pregnancy. We would like to present such a case with very good outcome.

Case: 28-year-old woman was admitted with palpitations, hypertension, flushing and throbbing headache during her second pregnancy. She was prescribed sertraline and also a beta blocker for anxiety. Her symptoms were persistent. The suspicion of pheochromocytoma was raised, as she had paroxysmal hypertension. Serum nor-metadrenaline were raised at >25,000 pmol/L. MRI scan revealed a 59×54×58 mm right adrenal mass. She was treated with Phenoxybenzamine and Bisoprolol. MDT (Obstetrician, endocrinologist, Endocrine surgeon, Neonatologist and Anaesthetist) decided to arrange elective LSCS and a planned adrenalectomy after the delivery after MIBG scan. She had an uneventful perioperative period and delivered a healthy baby. A month later she had her right adrenalectomy and her biochemistry normalised. She is waiting for genetic screening.

Discussion: This is a complex condition with rare occurrence. Some of the symptoms are associated with pre-eclampsia and can be present in normal pregnant women. However, the paroxysmal nature of the symptoms should raise the suspicion. Plasma metanephrines are extremely useful. If they are normal, it confidently rules out the condition whereas borderline values should be repeated. An experienced MDT team is very useful in planning the time and mode of delivery. Caesarian section (19% mortality rate) is preferred and safer than vaginal delivery (31%). There are certain medications that can precipitate ‘Pheo’ crisis that are routinely used during pregnancy including steroids for pre-term labour. MRI is preferred radiological investigation during pregnancy. Use of alpha blocker reduces the mortality. It is very important to prevent ‘Pheo’ crisis and as well as preparing the patient for tumour removal. This case highlights the importance well-co-ordinated MDT approach for the best outcome.