PHEOCHROMOCYTOMA IN PREGNANCY: A DIAGNOSIS NOT TO BE MISSED

Problem Statement

Pheochromocytoma is a rare, potentially serious disease due to the associated hypertensive crises and inherent risk to life.

The challenge lies in the timely diagnosis of this cause of hypertension in pregnancy to improve the maternofetal outcomes.

Methods

Review of clinical case and literature about pheochromocytoma

Results

We present a 36-year-old pregnant woman, IIG IP (induced vaginal delivery due to preeclampsia). She was referred to our hospital for chronic hypertension near 10 weeks of gestation. At that time, she present also palpitations and night sweats. Lowering the blood tension was not easy despite medical treatment. We performed urinary and serological analyses and imageology exams. A diagnosis of pheochromocytoma was made after the evaluation of urinary and plasmatic metanephrines at 24 weeks of gestation.

While hospitalized, alpha-adrenergic blockade was started with phenoxybenzamine. After a multidisciplinary meeting, it was decided to postpone adrenalectomy to the postpartum period.

The pregnancy was complicated by severe hypertensive crises and need of urgent delivery despite therapeutic measures. We delivered by c-section a masculine newborn of 1020g, Apgar Index 9/9/10 at 29 weeks of gestation. The woman was posteriorly submitted to adrenalectomy surgery.

Conclusions

Notwithstanding this rare etiology of hypertension, pregnancy is a privileged period for its diagnosis. Thus, the headache-sweating-palpitations triad should evoke pheochromocytoma to the obstetrician. The prognosis is directly associated with timely diagnosis as well as multidisciplinary management.