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


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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Available from: Samir Haddad, May 01, 2015
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    • "Pheochromocytoma crisis during pregnancy is rare and it is usually associated with hypertension, although non-hypertensive acute pulmonary oedema and cardiogenic shock have been described [5-8]. The crisis mainly occurs close to delivery or following exposure to pharmacologic agents, which was not the case [7-9]. "
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    ABSTRACT: Pheochromocytoma crisis typically presents as paroxysmal episodes of headache, tachycardia, diaphoresis or hypertension. We describe an uncommon case of recurrent non-hypertensive heart failure with systolic dysfunction in a young female due to pheochromocytoma compression. It presented as acute pulmonary oedema while straining during pregnancy and later on as cardiogenic shock after a recreational body massage. Such crisis occurring during pregnancy is rare. Moreover, of the few reported cases of pheochromocytoma-induced cardiogenic shock, recreational body massage has not yet been reported as a trigger for this condition.
    Full-text · Article · Jun 2014 · International Archives of Medicine
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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.
    No preview · Article · Jan 2014 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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    ABSTRACT: Objective: Diagnosis of pheochromocytoma during pregnancy can be difficult and the tumor carries an unfavorable prognosis if not diagnosed and treated in a timely manner.Methods: To present a case, of Takotsubo-like cardiomyopathy, characterized by transient left ventricular apical ballooning due to pheochromocytoma following delivery.Results: A few hours after Caesarean section a 32-year-old Caucasian woman presented with pulmonary edema followed by cardiac arrest, with echocardiographic and ventriculographic evidence of reversible acute myocardial failure characteristic of Takotsubo-like cardiomyopathy. A previously unrecognized adrenal pheochromocytoma was found during further clinical work-up. Left ventricle function normalized after surgical removal of the tumor carried out after implementing alpha-adrenoreceptor blockade. Hemorrhagic necrosis of the pheochromocytoma was seen on histopathology, which might have triggered the sequence of events leading to the development of Takotsubo-like cardiomyopathy and hemodynamic collapse.Conclusion: To the best of our knowledge we describe here the first reported case of Takotsubo-like cardiomyopathy related to pheochromocytoma following the delivery. This emphasizes the increased cardiovascular risk if pheochromocytoma is not diagnosed and treated in a timely manner especially during pregnancy.
    Full-text · Article · Aug 2014 · Endocrine Practice
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