Undiagnosed Pheochromocytoma During Pregnancy Presenting Initially With Neurological Manifestations: A Case Report

A 50-year-old pregnant woman (G3Ab2) who had her fourth IVF procedure during the first trimester of her pregnancy is described in this article as having a rare incidence of acute paraplegia. The patient's early symptoms included headache, sudden lower limb weakness, urine retention, back discomfort, and uncontrolled hypertension. The patient had a history of infertility, thyroidectomy, hypertension, and repeated spontaneous abortions. After transverse myelitis was confirmed by spinal MRI, methylprednisolone pulse therapy and plasmapheresis were started as treatments. Subsequent analysis of CSF fluid showed purulent meningitis. An unexpected abortion occurred 48 h later. She had fast hypotension, confusion, and a hemoglobin drop from 10 to 5 g/dL over 72 h. A tumor in the left adrenal gland and a sizable, active hematoma in the right adrenal gland were discovered by abdominal imaging. After a right adrenalectomy and mass draining were done in an emergency, the pheochromocytoma was finally diagnosed. The patient was briefly stabilized postsurgery but ultimately succumbed. This case is one of the limited instances documented in the scientific literature, when the emergence of neurological symptoms from transverse myelitis serves as the initial manifestation of pheochromocytoma, in conjunction with high-risk pregnancy, IVF, and an aggressive clinical trajectory. Consequently, in instances of unstable or early hypertension in pregnancy with neurological symptoms, differential diagnosis should include neuroendocrine tumors such as pheochromocytoma.