Pheochromocytoma in pregnancy: experience in the diagnosis, treatment and follow-up

Abstract

The aim is to analyze clinical variants of pheochromocytomas in pregnant women, find out the peculiarities of symptoms, diagnosis and surgical treatment based on the own clinic experience and literature review.Materials and methods. The results of the monitoring and treatment of 5 patients with pheochromocytoma (incl. 3 with bilateral, as a component of hereditary syndromes), identified during pregnancy and operated in clinic within 2001-2012 years are shown.Results and discussion. Two patients with biateral pheochromocytoma were operated using two stages total adrenalectomy (first – during pregnancy, removing the bigger tumor), followed by the prescription of hydrocortisone replacement therapy. One woman refused to complete adrenalectomy after delivery, being underwent successful unilateral adrenalectomy during pregnancy, and stays now under supervision. Two women with apparently sporadic unilateral pheochromocytoma were underwent laparoscopic unilateral adrenalectomy (during 2nd trimester of pregnancy). All patients demonstrated normalization of blood pressure and general condition without need for replacement therapy till the end of pregnancy. In cases of persistent smaller contrlateral tumor we conducted the last weeks of pregnancy and delivery on the cover of alpha-blockers. All mothers and children are alive.Conclusions. Hypertension in pregnant women should be considered as a potential hidden pheochromocytoma. Staged total bilateral laparoscopic adrenalectomy (first – from the side of bigger tumor during 2nd trimester of pregnancy after short prеparation with alpha-blockers) could be the operation of choice in case of hereditary bilateral pheochromocytoma; tumor on the other side can be safely removed after delivery, avoiding perinatal mother adrenal insufficiency. Genetic testing of patients and their children could be useful in order to identify the hereditary nature of the disease, given the high probability of syndromic variants of pheochromocytoma in pregnancy.