Endocrine Abstracts

Introduction: The discovery of a pheochromocytoma during pregnancy is very rare. The diagnostic and therapeutic approach determines the maternal and fetal prognosis. We present the case of a pheochromocytoma discovered during a pregnancy of 16 weeks of amenorrhea.

Case report: Mrs. A.H 29 years old, primigravida, presented at 6 weeks of amenorrhea with hypertension, she was treated by alpha methyl dopa 500mg and nicardipne 20mg; at 16 weeks she was hospitalized for an hypertensive peak at 20 mmHg without edema or proteinuria. A detailed patient history revealed pulsatile headache; heart palpitations and profuse sweats. The diagnosis of pheochromocytoma was suggested. The normetanephrine and metanephrine blood level were respectively at 4.75 nmol/l (<1.29) and at 0.19 nmol/l (<0.92). Adrenal ultrasound showed heterogeneous mass arising from the right adrenal gland of 53*66 mm. The hormonal and imaging tests detecting multiple endocrine neoplasia were negative. We have kept nicardipine and replaced Alphamethyldopa by an alpha blocker. Obstetric ultrasonography was normal. Pheochromocytoma resection by laparoscopy was decided at the end of 28 weeks. Post-operatively the rate of blood catecholamines decreased by half in one month and the patient blood pressure was easily controlled with calcium channel blockers alone. At 35th week an emergency cesarean section was performed because of an acute fetal distress, she delivered a healthy baby boy who presents a sexual development disorder that we are exploring.

Discussion: The initial diagnosis of hypertension during pregnancy is frequently attributed to pre-eclampsia rather than pheochromocytoma. This Confusion is the main cause of overlooking the diagnosis. Our patient had presented a blood hypertention since the 6th weeks of amenorrea but the diagnosis of pheochromocytoma was confirmed at only the 16 week. The lack of knowledge of the diagnosis exposes to the risks of a secretory thrust which can be fatal for the mother and the fetus. Early diagnosis and multidisciplinary medical management that prepares for the excision of the tumor is always necessary.