Pheochromocytoma in pregnancy: a case report and review of literature

Abstract

Summary: Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although phaeochromocytoma is a rare cause of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. The diagnosis can be confirmed by measurement of plasma and urinary catecholamines and their metabolities followed by radiological localization of the tumour. Surgical resection of the tumour after adequate pre-operative control of hypertension using sequential alpha-followed by betablockers is the definitive treatment. In pregnancy, depending on the gestation at which diagnosis is made, the optimal timing for surgery is during the late first or early second trimester. When the pregnancy is more advanced, medical management followed by combined caesarean section and tumour resection closer to term is preferred.

Hypertension in Pheochromocytoma: Characteristics and Treatment

“…[57] To avoid complications, tumor resection should take place either in the first or second trimester (optimal), or after cesarean section when the fetus comes to term. [59] It is important to have close medical management of the patient during the gestation period.…”

Laparoscopic approach to pheochromocytoma in pregnancy: case report

“…The success of treatment will depend on the appropriate preoperative medical management, which should always be started with α-adrenergic blockade (phenoxybenzamine or prazosin) for adequate control of blood pressure ( 9 ). Pre-surgical preparation with this class of drugs is one of the main reasons why surgical mortality has decreased over the last 30 years to <3% ( 5 ).…”

“…Surgical resection of the tumor is the definitive treatment for PCC, which can be achieved either by open, laparoscopic, or robotic approaches ( 1 , 6 , 8 ). Laparoscopic adrenalectomy is the surgical approach of first choice if tumor size is <7 cm ( 4 , 10 , 11 ); this is a safe procedure with a complication rate <8% ( 5 , 9 ). Although the posterior retroperitoneoscopic approach seems to be a good alternative for adrenalectomy than laparoscopic transperitoneal approach, avoiding the need to enter the peritoneal cavity, there is no evidence that supports the superiority of one over the other, both showing similar low morbidity and mortality ( 11 ).…”

Hypertension artérielle et arrêts de grossesse : penser au phéochromocytome

“…En effet, le phéochromocytome peut être rarement révélé par la grossesse [7]. Environ 200 cas d'association de phéochromocytome et grossesse ont été publiés dans la littérature [8]. Ceci s'explique par la rareté de la maladie et la difficulté de son diagnostic au cours de la grossesse.…”

“…Un phéochromocytome non diagnostiqué chez une femme enceinte est responsable de mortalité maternelle de 48% et de mortalité foetale de 54,4%. La mort foetale serait due essentiellement à des variations hémodynamiques [8].…”