Adrenal Tumors and Pregnancy

Abstract

Although adrenal tumors detected during pregnancy are extraordinarily rare, the pathophysiologic repercussions of untreated adrenal neoplasms are enormous to both mother and fetus. From our computer-based registry of pregnant patients from 1975 through 1996 (n = 30,246), four cases of adrenal neoplasms associated with pregnancy were identified (0.013%), analyzed, and compared with the current medical literature. Four women ages 36, 29, 22, and 21 years had adrenal neoplasms diagnosed with pregnancy. Patient 1 had an unsuspected pheochromocytoma identified at autopsy. At 27 weeks into her pregnancy the patient suffered a myocardial infarction, and both she and the fetus died. Patient 2 was incidentally found to have adrenal and pancreatic neoplasms on screening abdominal computed tomography for von Hippel-Lindau disease. The study identified a pregnancy. She elected to terminate the pregnancy and underwent resection of both tumors. She died 3 years later of metastatic islet cell cancer. Both of these patients had previously delivered healthy babies, but both pregnancies were complicated by hypertension. Patient 3 had a functional adrenal tumor identified initially by urinary aldosterone studies because of symptoms of severe hypertension, and patient 4 had an adrenal mass diagnosed via ultrasonography at 30 weeks' gestation because of concerns for right-sided pyelonephritis. These two women underwent careful monitoring throughout the remainder of their pregnancies with eventual delivery of healthy babies. Both women later underwent successful operative resection of benign adrenal adenomas. Adrenal neoplasms discovered during pregnancy are rare. The onus, however, is on physicians to consider this diagnosis in pregnant women with hypertension, headaches, or other manifestations of adrenal disorders. Surgical management of identified adrenal lesions is thereafter straightforward. Missing the diagnosis has grave implications for these young women and their fetuses.

Management of pituitary adenoma with mass effect in pregnancy: a case report

“…Anaesthesia for pituitary disease is a highly specialized area and because the reported cases are few [2], especially during pregnancy, extensive experience in this area is often lacking. Prolactinomas are the commonest pituitary tumors complicating pregnancy.…”

ENDOCRINE DISORDERS IN PREGNANCY: Pheochromocytoma and pregnancy: a deceptive connection

“…In pregnant patients, the optimal time for surgical tumor removal is critical and it has been advised that the tumor is removed either before 24 weeks of gestation or after delivery (4,8,57). The second trimester is the safest period to do surgery during pregnancy because of the risk of spontaneous abortion in the first trimester (58).…”

“…During pregnancy, the occurrence of a pheochromocytoma is even more rare and has been estimated to be present in one in 54 000 pregnancies (4,5). Yet, despite being an uncommon condition in pregnancy, recognizing it timely in a pregnant hypertensive woman is extremely important since if it remains undiagnosed and untreated, maternal and fetal mortality amounts to 40-50% (6,7).…”

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

“…In these conditions, hypertensive emergency, acute pulmonary edema, malignant arrhythmias, myocardial ischemia or infarction, aortic dissection, cardiac failure and hemodynamic collapse are well-recognized complications of pheochromocytoma, and the risk of death is high after such acute presentations unless appropriate therapy is instituted quickly (34). Few case reports have described such conditions, with varying outcomes for both mother and child (1,17,34,35,40,41,42,43).…”

“…Pheochromocytomas in pregnancy are rare with an incidence of 0.007% in a large series describing 30 246 pregnancies collected in 20 years (1). Autopsy studies, however, suggest a higher incidence (2).…”