Mahajna M*, Weinstein J, Samueloff A, Ioscovich A, Neumann M, Reissman P, Frankel M, Ofer B and Grisaru-Granovsky S
Sharee Zedek Medical Center, Jerusalem, IsraelFulltext PDF
Background: Pheochromocytoma [PHEO] in pregnancy is extremely rare. A late diagnosis, unplanned pregnancy course and delivery are related to a 40% to 50% maternal and fetal mortality risk. Conversely, early detection and treatment significantly reduces both to 5% to 15%. Based on a literature review and our implications for the present case report, we suggest a multidisciplinary diagnosis and management algorithm PHEO in pregnancy. Case Report: A 35-year-old primigravida at 27+1 weeks of Gestation [GA] presented with headache and previously diagnosed chronic Hypertension [HTN] aggravation. Complete evaluation ruled out pregnancy related HTN. A high suspicion level for an alternative cause for HTN was raised. Appropriate imaging studies revealed a heterogenous mass adjacent to the left adrenal 8 cm × 7 cm in diameter, highly suspicious for adrenal tumor. Elevated urine catecholamines confirmed the diagnosis of PHEO. A multidisciplinary team was formed and a joint decision for disease control and delayed surgery until after delivery was taken. Blood pressure control was achieved by a combined alpha and beta-adrenergic blocker approach at levels of 135-140/80-90. Antenatal steroids for fetal lung maturation were administered with concurrent 24 h BP Holter. Her condition remained stable and at 32+0 GA a planned cesarean section delivery using a minimal intraperitoneal handling technique under neuraxial anesthesia. A male newborn of 1,960 g was delivered, 1’/5’ Apgar score 6/9. The medical therapy was continued with lower BP goals and a planned laparoscopic adrenalectomy performed after 2 weeks of postpartum recovery. The mother and child were discharged in good condition. Conclusion: The maternal and fetal lethal consequences of PHEO during pregnancy may be prevented by a high index of suspicion for the diagnosis and following a multidisciplinary algorithm of management, adapted to the individual patient, mainly based on achievement of BP control and the gestational age.
Mahajna M, Weinstein J, Samueloff A, Ioscovich A, Neumann M, Reissman P, et al. Pheochromocytoma in Pregnancy: A Multidisciplinary Challenge and a Proposed Management Algorithm. Clin Case Rep Int. 2022; 6: 1417.