Secondary Hypertension in Pregnancy

Malha, Line; August, Phyllis

doi:10.1007/s11906-015-0563-z

Cited by 100 publications

(40 citation statements)

References 74 publications

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“…Other endocrine etiologies include pheochromocytoma and primary aldosteronism, while non-endocrine etiologies are mainly represented by renal artery stenosis and obstructive sleep apnea (23). Pheochromocytoma is the most common tumoral cause of hypertension during pregnancy.…”

Section: How To Diagnose Cs During Pregnancy?mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing’s syndrome during pregnancy: solved and unsolved questions

Brue

Amodru

Castinetti

2018

European Journal of Endocrinology

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With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2- to 3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. Apart from gestational hypertension, differential diagnosis includes pheochromocytoma and primary aldosteronism. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare and has poor prognosis. Active CS during pregnancy is associated with a high rate of maternal complications: hypertension or preeclampsia, diabetes, fractures; more rarely, cardiac failure, psychiatric disorders, infection and maternal death. Increased fetal morbidity includes prematurity, intrauterine growth retardation and less prevalently stillbirth, spontaneous abortion, intrauterine death and hypoadrenalism. Therapy is also challenging. Milder cases can be managed conservatively by controlling comorbidities. Pituitary or adrenal surgery should ideally be performed during the second trimester and patients should then be treated for adrenal insufficiency. Experience with anticortisolic drugs is limited. Metyrapone was found to allow control of hypercortisolism, with a risk of worsening hypertension. Cabergoline may be an alternative option. The use of other drugs is not advised because of potential teratogenicity and/or lack of information. Non-hormonal (mechanical) contraception is recommended until sustained biological remission is obtained.

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Section: How To Diagnose Cs During Pregnancy?mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing’s syndrome during pregnancy: solved and unsolved questions

Brue

Amodru

Castinetti

2018

European Journal of Endocrinology

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“…Screening for secondary HT should be considered in each woman planning to conceive who presents with HT based on routine assessment findings and detailed medical history [3,4,18] (Tab. 4.2).…”

Section: Treatment Of Ht In Women At Reproductive Agementioning

confidence: 99%

“…vesicoureteral reflux, glomerulonephritis), renal artery stenosis from fibromuscular dysplasia, pheochromocytoma, coarctation of the aorta or primary aldosteronism. Secondary HT affects about 0.2% of all pregnancies and is diagnosed in 2-5% of all pregnant women with HT treated in highly specialist centres [18]. Diagnostic management of HT in women planning to conceive should be further extended to include kidney ultrasound and renal artery Doppler ultrasound.…”

Section: Treatment Of Ht In Women At Reproductive Agementioning

confidence: 99%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

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Disclaimer: The position statement represent the views of the authors and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The authors and societies are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the position statement and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the position statement fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies. 118 www.ah.viamedica.pl ABPM -ambulatory blood pressure monitoring ACE-I -angiotensin-converting enzyme inhibitor AF -atrial fibrillation AFI -amniotic fluid index AFL -atrial flutter AGA -appropriate for gestational age AHI -apnea hypopnea index AKI -acute kidney injury ALT -alanine transaminase ARB -angiotensin receptor blocker ARR -aldosterone-to-renin ratio AST -aspartate aminotransferase AT -atrial tachycardia BAV -bicuspid aortic valve BMI -body mass index BNP -B-nariuretic peptide BP -blood pressure Bpm -beats per minute BPP -biophysical profile CABG -coronary artery bypass graft CAD -coronary artery disease CKD -chronic kidney disease CNS -central nervous system CoA -coarctation of the aorta CPAP -continuous positive airway pressure CPR -cerebroplacental ratio CTG -cardiotocography CV -cardiovascular DBP -diastolic blood pressure DIC -disseminated intravascular coagulation DM -diabetes mellitus ECMO -extracorporeal membrane oxygenation ECG -electrocardiography EF -ejection fraction ESC -European Society of Cardiology ESH -European Society of Hypertension EVA -early vascular ageing FDA -Food and Drug Administration FHR -foetal heart rate FIGO -International Federation of Gynaecology and Obstetrics FMD -fibromuscular dysplasia FMF -Fetal Medicine Foundation FPS -frame per second GFR -glomerular filtration rate HELLP -hemolysis, elevated liver enzymes, low platelet countuterine growth restriction IVF -in vitro fertilisation LBBB -left bundle branch block LBW -low birth weight LDH -lactate dehydrogenase LQTS -long QT syndrome LVAD -left ventricular assist device LVEF -left ventricular ejection fraction MAP -mean arterial pressure MCA -middle cerebral artery MCS -mechanical circulatory support MDT -multidisciplinary team MRA -mineralocorticoids renceptor antagonist MRAs -mineralocorticoids renceptor antagonists MRI -magnetic resonance imaging NSTEMI -non-ST elevation myocardial infarction NT-BNP -N-terminal pro-BNP NTS -non-stress-test OGTT -oral glucose tolerance test OSA -obstructive sleep apnoea p.o. -per os PA -primary aldosteronism PAPP-A -pregnancy associated placental protein PCI -percutaneous coronary intervention PE -pre-eclampsia PI -pulsatility index PlGF -placental growth factor PPCM -peripartum cardiomyopathy PPGL -pheochromocytoma a...

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“…Sustained hypertension or hypertensive crises are dangerous to the mother; moreover, vasoconstriction in the uteroplacental circulation caused by excess catecholamines can lead to intrauterine hypoxia and placental abruption [4]. Despite the rarity of such a diagnosis, physicians should be aware of pheochromocytoma as one of the possible causes of gestational hypertension [5]. As our cases prove, caution should be taken when examining even the asymptomatic patients with germline mutations associated with this tumour.…”

Section: Discussionmentioning

confidence: 76%