Endocrine Abstracts

A 34-year old lady presented in the postpartum period following her 3rd pregnancy with severe hypertension. Her first two pregnancies were 3 and 5 years previously where she delivered via elective Caesarean section without any complications. During this pregnancy which was a twin pregnancy, her antenatal care was mainly unremarkable but on specific questioning, she reported increased sweating for a period of 4 months. Her blood pressure was noted to be normal during her antenatal care. When she was 35 weeks pregnant, she became unwell with significantly increased sweating. On admission to the labour ward, her blood pressure was 194/149 mmHg and urine dipstix revealed 2+ proteinuria. A diagnosis of severe pre-eclampsia was made and she was treated with Nifedipine and Magnesium Sulphate. She had an emergency Caesarean section with delivery of a healthy set of twins. Post operatively, her blood pressure remained high necessitating IV Labetolol, Amlodipine and Ramipril. An ultrasound identified a 4.1 cm lesion in the right adrenal bed which was subsequently confirmed by MRI. Blood tests showed a normal dexamethasone suppression test and renin/aldosterone ratio. Two 24 h urine collections confirmed significantly elevated urinary metadrenaline levels at 38.8 μmol and 46.2 μmol respectively. She was commenced on phenoxybenzamine which was gradually titrated up and then referred for laparoscopic adrenalectomy.

Phaeochromocytomas in pregnancy are exceedingly rare with a frequency of 0.002% of all pregnancies. Although the fetus is not directly affected by the catecholamines, this condition can have potentially disastrous consequences for the mother and fetus as maternal hypertension can lead to placental insufficiency and placental abruption. In a recent systematic review looking at 77 case reports of phaeochromocytomas in pregnancy, 80% were diagnosed during pregnancy with the remaining within 1 month postpartum. Survival rates are improved if the diagnosis is made during the antenatal period. There was no definite advantage noted in proceeding with tumour removal during the second trimester.

We present a rare case of a phaeochromocytoma diagnosed in the postpartum period with a positive outcome for both mother and fetus.