Endocrine Abstracts

Introduction: Pheochromocytoma is a rare cause of hypertension in pregnancy. Its prevalence ranges from 0.2% to 0.002% of cases of hypertension in pregnancy. Early diagnosis and appropriate management can reduce mortality and morbidity. Were report a case of pheochromocytoma diagnosed during pregnancy.

Observation: 34-year-old diabetic patient, 29 weeks pregnant. Admitted for hypertensive peaks up to 170 mmHg of systolic, initially mistaken for pre-eclampsia. Given the 4-year history of hypertension associated with headaches and palpitations, endocrine hypertension was suspected. Urinary metanephrines were measured, and were very high (41 times upper limit for normethanephrine and 27 times for metanephrine). Abdominal MRI without gadolinium injection revealed a heterogeneous tumor above the left kidney measuring 7 cm, suggesting a pheochromocytoma. As the patient was already in her third trimester, surgery was postponed and the patient was put on alpha blockers and calcium channel blockers. Her blood pressure normalized under medical treatment. The patient had intrauterine fetal demise at 33 weeks and underwent adrenalectomy in the post partum.

Discussion: Pheochromocytoma is most common between the fourth and fifth decades of life, in both men and women. The diagnosis of pheochromocytoma in pregnant women is often difficult, and the presence of hypertension can be misleading. Persistent or paroxysmal hypertension is the most common sign of this disease. Headaches occur in up to 90% of symptomatic patients. Hypertension in pregnancy should be investigated early to differentiate pre-eclampsia from other causes. Urinary cathecolamines and metanephrines and MRI are used for diagnosis. Medical treatment with an alpha-blocker should be started as soon as the disease is diagnosed, and continued for at least 10 to 14 days before surgery. Surgery is the definitive treatment for pheochromocytoma, but the timing is controversial. Decisive criteria are gestational age, accessibility of the tumor, presence or absence of fetal distress, and the patient’s response to medical treatment. If the pregnant woman is in her 24th week of gestation or more, surgical removal is postponed until or after delivery. Despite its low prevalence, pheochromocytoma during pregnancy increases maternal and fetal morbidity and mortality.