Endocrine Abstracts

A 27-year-old woman with had sweating flushing attacks for three years prior to pregnancy, but did not follow with any medical examination. At 12th gestational week, hypertension was detected and alpha-methyldopa was started, no abnormal findings were found in the routine examinations, in the 24-h holter study, blood pressure values (using alpha-methyldopa) were found to be higher than 144/99 (general), 147/101 (awake) and 134/92 mmHg (sleep). 24-hour urinary levels of catecholamine and metabolites were significantly higher than normal ranges; noradrenaline was 787.99 μg/24 h, dopamine 3635.43 μg/24 h, normetanephrine 1605.31 μg/24 h. MR imaging revelaed a heterogeneous lesion (49×37 mm) in the left adrenal gland. Because of the early stage of pregnancy laparoscopic surrenalectomy was performed. Histopathologic examination revealed a tumor consistent with pheochromocytoma. In the follow-up, there was no maternal problem except hypotensive state but unfortunately, because of anhydramnios and intrauterine growth retardation, medical abortion was applied at the 27th gestational-week. Pheochromocytoma is a very rare cause of hypertension in pregnancy however, early detection are crucial because of the increased risk of maternal-fetal mortality. Therefore, in cases of high blood pressure which can not be explained by gestational hypertension, it is necessary to carefully evaluate other secondary causes such as pheochromocytoma. The most suitable period for the operation is the second-trimester. Surgical approach was used and no complication related to the operation occurred in our case. However, it was thought that the outcome of fetal loss due to developmental delay was related to the adverse effects of circulatory factors due to long-term illness in the patient. The fact that the patient could not be examined in the pre-pregnancy period and probably the prolongation of the duration of the illness resulted in a negative result. Especially in women of childbearing age, the importance of hypertension in terms of maternal and fetal outcomes is emphasized by this case report.