Article

Cardiorespiratory crisis at the end of pregnancy: a case of pheochromocytoma.

Intensive Care Department, MC 1425, Surgical Intensive Care Unit, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Middle East journal of anaesthesiology 06/2013; 22(2):195-202.
Source: PubMed

ABSTRACT Pheochromocytoma during pregnancy is extremely rare. Its clinical manifestation includes hypertension with various clinical presentations, possibly resembling those of pregnancy-induced hypertension. The real challenge for clinicians is differentiating pheochromocytoma from other causes of hypertension (preeclampsia, gestational hypertension, and pre-existing or essential hypertension), from other cause of pulmonary edema (preeclampsia, peripartum cardiomyopathy, stress or Takotsubo cardiomyopathy, pre-existing cardiac disease [mitral stenosis], and high doses betamimetics), and from other causes of cardiovascular collapse (pulmonary embolism, and amniotic fluid embolism). Although, several cases of pheochromocytoma during pregnancy have been published, fetal and maternal mortalities due to undiagnosed cases are still reported. We report a case of a patient whose delivery by cesarean section was complicated by severe hemodynamic instability resulting in a cardiac arrest. Later on, pheochromocytoma was suspected based on computed tomography (CT) scan findings. Diagnosis was confirmed with special biochemical investigations that showed markedly elevated catecholamines in urine and metanephrines in serum, and later by histopathology of the excised left adrenal mass. This case illustrates the difficulty of diagnosing pheochromocytoma in pregnancy and raises the awareness to when this rare disease should be suspected.

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    ABSTRACT: Abstract Objective To investigate the diagnosis and treatment of pheochromocytoma during pregnancy. Material and Methods The data of 4 cases of pheochromocytoma was analyzed retrospectively. Their ages were 41, 28, 32, and 30 years old, and t he four patients were at 32 week , 12 week , 14 week and 13 week of gestation . All patients had hypertension during pregnancy, accompanied with headache, dizziness, palpitation and sweating. The 24-hour urinary catecholamines (24h UCA) increased significantly. Ultrasound and MR I confirmed the diagnosis of pheochromocytoma. . Results 1 case had Cesarean section at 32 weeks of gestation, and a healthy baby girl was delivered smoothly. Laparoscopic resection of the right adrenal pheochromocytoma was performed at the same time, and an adrenal tumor of 7.0cm was resected successfully. 2 cases chose abortion, and laparoscopic resection of pheochromocytoma was performed. 1 case chose abortion, and refused further treatment. Histopathology confirmed the diagnosis of pheochromocytoma. Conclusions For hypertension in pregnant women during pregnancy, typical paroxysmal hypertension accompanied by triad of headache, palpitation and sweating, pheochromocytoma should be considered. Early diagnosis can reduce the maternal and fetal mortality significantly. Second trimester of pregnancy is the ideal time for surgical treatment. Laparoscopic resection of pheochromocytoma during pregnancy is safe and effective.
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