Management Of Catecholamine-Secreting Tumors In Pregnancy: A Review

Prete, Alessandro; Paragliola, Rosa Maria; Salvatori, Roberto; Corsello, Salvatore Maria

doi:10.4158/ep151009.ra

Cited by 33 publications

(38 citation statements)

References 66 publications

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“…Pretreatment with α-adrenergic receptor blockade for at least 10-14 days before surgery results in a lower risk of perioperative and postoperative complications due to a reduction in blood pressure, a reduced risk of paroxysmal increases in blood pressure and (partial) restoration of normal blood volume (7,16). In non-pregnant patients, target blood pressure is <130/80 mmHg while in seated position and systolic blood pressure >90 mmHg while in standing position (16).…”

Section: Pretreatmentmentioning

confidence: 99%

“…Most commonly used α-adrenergic receptor blockers are phenoxybenzamine (generally used dosages: 10-40 mg twice a day) and doxazosin (generally used dosages: 4-16 mg twice a day) (16). For many years, phenoxybenzamine (fetal risk category C) has been the alpha blocker of choice in pregnant patients with pheochromocytoma showing good neonatal outcomes in many case reports (7). A disadvantage of phenoxybenzamine might be that it is supposed to pass the placenta (22).…”

Section: Pretreatmentmentioning

confidence: 99%

“…Apart from hypertensive periods, periods of hypotension are commonly seen in patient with pheochromocytoma. During pregnancy, pheochromocytoma-related hypotension is found in about 50% of the patients (7).…”

Section: Symptomsmentioning

confidence: 99%

“…Pregnancyrelated hypertension usually develops only after 20 weeks of menstrual age while pheochromocytoma can present with hypertension at any time during pregnancy. Moreover, hypertension in pheochromocytoma is often paroxysmal and periods of hypotension can occur as well (7). Therefore, especially patients presenting with severe hypertension before 20 weeks of menstrual age and/or paroxysmal hypertension or hypotension need to be screened for pheochromocytoma.…”

Section: Symptomsmentioning

confidence: 99%

“…Slightly increased results may be false positive due to limitations of the test or problems with collection of the materials. Results must also be interpreted with caution when patients are already using methyldopa or labetalol as these medications can lead to false-positive results in assays using liquid chromatography with fluorescence detection (7,11). Provocation tests, such as the clonidine suppression test, should be avoided because of low sensitivity and potential serious side effects (9,11).…”

Section: Diagnosismentioning

confidence: 99%

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

Weerd

Noord

Loeve³

et al. 2017

European Journal of Endocrinology

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Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.

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Section: Pretreatmentmentioning

confidence: 99%