Diagnosis and managementof pheochromocytoma in pregnancy

Abstract

：Objective To discuss thediagnosis and management of pheochromocytoma in pregnancy. Methods Three cases ofpheochromocytoma in pregnancy were managed from 2007- 2009.Case 1, a 41-year-old womanpresented with paroxysmal hypertension during 27+1 weeks' gestation.The accompaniedsymptoms included dizziness, palpitation and sweating. Both B ultrasound and MRI revealeda right adrenal tumor about 7 cm in diameter. The 24-hour catecholamine was higher thannormal. A diagnosis of right adrenal pheochromocytoma was made. Case 2, a 28-year-oldwoman presented with hypertension during 12+4 weeks' gestation. B ultrasound showed aright adrenal tumor about 5 cm in diameter. The 24-hour catecholamine was higher thannormal. Case 3, a 32-year-old woman presented with hypertension during 14+3 weeks'gestation. B ultrasound revealed bilateral adrenal tumors. The 24-hour catecholamine washigher than normal. The diagnosis of bilateral adrenal pheochromocytomas was made. ResultsThe first patient delivered a healthy female infant through cesarean section at 32 weeks'gestation. Laparoscopic resection of right adrenal pheochromocytoma was successfullyperformed at the same time. Both the second and third patients had elective abortion forfear of fetotoxicity. Case 2 accepted laparoscopic resection of right adrenalpheochromocytoma after 4 weeks' medical preparation. Case 3 rejected surgery. Thehistopathological findings proved pheochromocytoma in case 1 and case 2. ConclusionsPheochromocytoma should be included in the defferential diagnosis in hypertensionoccurring during pregnancy especially in the following situations:hypertension duringearly pregnancy; paroxymal hypertension accompanied by headache, palpitation and sweating;hypertension does not relieve after delivery. Early diagnosis and management with medicaltreatment followed by surgical removal usually results in good maternal and fetaloutcomes. The second trimester is good timing of surgical management. Laparoscopic removalof pheochromocytoma is safe in pregnancy.