Endocrine Abstracts

Introduction: Pheochromocytoma in pregnancy is rare with an incidence of 0.007%. A timely diagnosis is essential since fetal and maternal mortality depends on the early treatment. Our object is to report a pheochromocytoma diagnosed in a patient at the beginning of the pregnancy and to highlight the particularity in the therapeutic care.

Case presentation: A 32-year-old female patient was admitted to our endocrinology department for exploration of palpitation associated with headache and sweats. She had a family history of diabetes and hypertension and no history of pituitary adenoma or hyperparathyroidism. The symptoms were concomitant to food intake, and evolving for 02 years. The patient decreased her diet to avoid the symptoms, therefore, losing 09 kg. Clinically, her systolic blood pressure was ranging between 140 and 170, and diastolic between 80–90 mmHg. Pheochromocytoma was suspected and confirmed with increased plasma normetanephrine and metanephrine levels (10* the normal range). Abdominal CT scan showed a heterogenous mass of the left adrenal gland (5*4 cm) with spontaneous density of 40UH. Shortly after, the patient discovered she was 9 weeks pregnant. We started treatment with doxazosin, and blood pressure values were normalized. At 18 weeks of menstrual age, laparoscopic adrenalectomy of the left adrenal gland was performed without any complications during or after surgery. The tumor was confirmed to be a 7-cm pheochromocytoma in histological exam. After surgery, blood pressure was normal without treatment and post-operative measurements of serum normetanephrines and metanephrines were normal. At 30 weeks of menstrual age, the fetus was healthy.

Conclusion: Maternal and fetal mortality du to pheochromocytoma decreases to less than 15% if the diagnosis was made antepartum. Symptoms in pregnant patients do not differ from symptoms in non-pregnant patients. However, they may worsen with advancing pregnancy due to an increased pressure on the tumor by the abdominal distension, fetal movements and uterine contractions. When the diagnosis is made within the first 24 weeks of pregnancy and adequate α-blockade can be established, tumor removal is recommended in the second trimester via laparoscopic surgery. Decisions for those patients should be made by an experienced multidisciplinary team.