A Unilateral Large Adrenal Tumor First Identified during Pregnancy: A Diagnostic and Therapeutic Dilemma
2Department of Medicine, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
3Department of Obstetrics and Gynecology, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
4Department of Endocrine Laboratory, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
Introduction:
Adrenal non-adenomatous tumors (NAT) first identified during pregnancy are very rare and pose a diagnostic and therapeutic dilemma with significant risks for the mother and fetus.
Aim:
To report a case of a large adrenal NAT identified in pregnancy and literature review.
Methods:
A literature search conducted, and data summarized.
Case Presentation:
A 37-year-old primigravida women, with a history of melanoma excised 12 years prior to presentation without recurrence, presented at 35 weeks׳ gestation due to intractable right flank pain. MRI demonstrated an eight cm, heterogeneous, septate, right adrenal mass suspected to be either pheochromocytoma, adrenocortical carcinoma (ACC) or metastasis. Blood metanephrines were sent urgently to enable a safe delivery and were within normal range, as were cortisol and androgen levels. A day later she delivered by cesarean section. PET CT done after delivery revealed extensive metastatic spread of recurring melanoma including the adrenal.
The most commonly reported adrenal NAT in pregnancy is Pheochromocytoma. Most were secreting with leading symptoms of hypertension, palpitations and headaches. All women needed medical treatment prior delivery. Significant maternal morbidity exists despite treatment. A few case reports identified ACC first recognized during pregnancy. The leading presentation was Cushing`s. Maternal and fetal prognosis is poor. A few case reports identified metastasis from breast and lung cancers. None reported adrenal metastatic melanoma.
Conclusions:
Timely diagnosis and management by a multidisciplinary team are important to avoid a catastrophic outcome. There is no consensus on optimal management and timing of delivery. Pheochromocytoma should be ruled out before delivery.
