Pheochromocytoma and pregnancy: complications and solutions (case report)

Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. A patient with paroxysmal hypertension, postpartum intraabdominal bleeding, and a recognized pheochromocytoma is described. A 36-yr-old previously practical healthy woman (gravida 4, para 3) presented to our tertiary care centre at at 26 weeks four days gestation with a history of labile blood pressure and severe hypertension. A two week prior to admission she began having episodes of severe headache, sweating, nausea and dizziness. On an obstetric visit she was noted to be severely hypertensive with a blood pressure of 220/120 mmHg. Ultrasound imaging demonstrated a 11,6 cm x 9,2 cm right adrenal mass, biochemical investigations confirmed the diagnosis of pheochromocytoma. The patient was invasively monitored in the intensive care unit and treated with alpha-blockers and doxazosin. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. Childbirth was performed by elective Cesarean Section with simultaneous laparatomic right-sided adrenalectomy. Postoperative period was complicated with intraabdominal bleeding consequently treated during relaparatomy. The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, usage of alpha-blockers, and avoidance of a hypertensive crises during delivery and definitive surgical treatment. Timing of surgical resection will depend on the gestational age at which diagnosis is made. Cesarean section is the preferred mode of delivery when the tumor is still present. Complications such is bleeding from adrenalectomy site should be considered. This case illustrates that with antenatal diagnosis, advanced methods of tumor localization, adequate preoperative adrenergic blockade and team planning, pheochromocytoma in pregnancy can be treated successfully even in complicated cases.