Endocrine Abstracts

Introduction: Pheochromocytomas are rarely diagnosed in pregnancy. The consequences of pheochromocytoma during pregnancy can be devastating for both mother and fetus. Effective treatment requires an accurate and early diagnosis, but sometimes the tumor is diagnosed relatively late, so it is absolutely necessary to respond quickly and effectively.

Purpose: The aim of our study is to describe a patient with a history of medullary thyroid cancer who underwent surgery for bilateral pheochromocytoma in the 21st week of pregnancy.

Material and method: A 33-year-old woman with a germline mutation of the RET 634 proto-oncogene and who had undergone surgery for medullary thyroid cancer (MEN2A syndrome) several years earlier was hospitalized for examination of bilateral adrenal tumors, detected during a routine ultrasound examination due to pregnancy, confirmed by MRI. In the past, the patient gave up endocrine follow-up several years after thyroid surgery. On the day of admission, the patient was 18 weeks pregnant and did not report any symptoms. Blood pressure was 127/85 mm Hg with a regular heart rate of 120 bpm. MRI scans and double checking for urinary catecholamine metabolites, which were well above the reference range, revealed bilateral pheochromocytoma. Perioperatively, alpha-blocker was used to prevent blood pressure spikes. After the patient consented to bilateral adrenalectomy, laparoscopic surgery was successfully performed in the 21st week of pregnancy. Histopathological examination of both adrenal tumors confirmed the diagnosis of bilateral pheochromocytoma. The tumors were 20x55mm in the right adrenal and 12×33mm in the left adrenal. The rest of the pregnancy and the delivery were uneventful. The natural birth took place at 37 weeks of pregnancy.

Conclusions: 1. Women with MEN2A syndrome should receive follow-up to prevent delays in pheochromocytoma detection, which can pose serious problems, especially if they become pregnant. 2. Surgery for bilateral pheochromocytoma in the second trimester of pregnancy can be performed with appropriate cooperation of an endocrinologist, gynecologist and surgeon. 3. Our patient and her child had a positive effect as a result of careful pharmacological and surgical treatment.