Pheochromocytoma And Pregnancy:A Rare But Dangerous Combination

Sarathi, Vijaya; Lila, Anurag; Bandgar, Tushar; Menon, P. S. N.; Shah, Nalini

doi:10.4158/ep09191.ra

Cited by 45 publications

(74 citation statements)

References 51 publications

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Section: Pregnancymentioning

confidence: 99%

“…In patients undergoing pheochromocytoma removal, intraoperative increase in arterial pressure has been shown to be associated with plasma norepinephrine and epinephrine release, which occurs in all patients i) when moving the patient on the table; ii) during induction of general anesthesia and tracheal intubation in relationship with intraabdominal pressure changes associated with cough, light sedation, and insufficient relaxation; iii) when abdominal pressure changes due to the initiation of mechanical ventilation; iv) during the creation of pneumoperitoneum; and v) when the tumor is directly manipulated (13,26,(48)(49)(50). Increased arterial pressure is also likely to be an exaggerated response to noxious stimuli not associated with catecholamine release such as skin incision (16,50 …”

Section: Cause Of Hemodynamic Instability In Pheochromocytoma Surgery?mentioning

confidence: 99%

“…Direct and continuous monitoring of arterial pressure via an intraarterial catheter is universally recommended (5, 16-18, 22, 23, 25-34, 41, 46, 47, 50). A central venous catheter is a routine part of patient care in many reports (18,30,49,50). Some teams believe that administering a vasopressor on a peripheral venous line to control transient intraor post-operative hypotension is not harmful (31).…”

Section: Anesthetic Techniquementioning

confidence: 99%

“…Aggressive medical control of blood pressure with antihypertensive drugs is regarded as a major factor in accounting for the dramatic improvement in maternal and fetal outcome in patients with pheochromocytoma diagnosed during pregnancy (48,49). Hypotensive drugs listed above have been used with good results (48,49). Selective b1-blockers such as metoprolol or atenolol must be favored over non-selective b-blockers such as propranolol, which were associated with growth retardations, neonatal bradycardias, and hypoglycemias in the fetus (48,49).…”

Section: Pregnancymentioning

confidence: 99%

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Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

126

143

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Adrenalectomy for pheochromocytoma is reported with a mortality close to zero in recent studies. The dogma of preoperative fluid and hypotensive drug administrations is widely applied in patients scheduled for pheochromocytoma removal and is assumed to have a beneficial effect on operative outcomes. This paradigm is only based on historical studies of non-standardized practices and criteria for efficacy, with no control group. Pre-and intraoperative hypovolemia have never been demonstrated in patients scheduled for pheochromocytoma removal. Recent improvements in outcome of patients undergoing adrenalectomy for pheochromocytoma could also be the result of improvement in surgical techniques and refinement in anesthetic practices. Whether better knowledge of the disease, efficiency of available intravenous short-acting vasoactive drugs, and careful intraoperative handling of the tumor make it possible to omit preoperative preparation in most patients scheduled for pheochromocytoma removal is presently questionable. We reviewed available literature in this respect.

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Section: Pregnancymentioning

confidence: 99%

Section: Cause Of Hemodynamic Instability In Pheochromocytoma Surgery?mentioning

confidence: 99%

Section: Anesthetic Techniquementioning

confidence: 99%

Section: Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

126

143

View full text Add to dashboard Cite

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“…Autopsy studies, however, suggest a higher incidence (2). A timely diagnosis during pregnancy is important as maternal and fetal mortality is approximately 40-50% if untreated (3), decreasing to less than 5% for maternal mortality and less than 15% for fetal mortality after treatment (4).…”

Section: Introductionmentioning

confidence: 99%

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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