Abstract
IntroductionPheochromocytoma, a neuroendocrine tumor that secretes catecholamines, can present with episodic sweating, diaphoresis, headaches, and hypertension, as well as cardiac and pulmonary involvement. In a pregnant patient, it must be differentiated from preeclampsia, a leading cause of maternal mortality in the developed world, which can similarly present with hypertension and multiorgan involvement. Both conditions require early diagnosis and treatment to reduce maternal and fetal morbidity and mortality.Case ReportWe discuss the case of a pregnant patient at approximately 24 weeks’ gestation presenting with chest pain and shortness of breath who was found to have a left adrenal mass and hypertensive urgency. The patient acutely decompensated during the course of evaluation. She ultimately suffered pregnancy loss and multiorgan failure requiring percutaneous heart pump placement and extracorporeal membrane oxygenation therapy for support before fully recovering. The adrenal mass was confirmed to be a pheochromocytoma after excision and contributed to the development of hypertensive emergency with multiorgan failure.ConclusionPheochromocytoma during pregnancy is a rare condition but must remain on the differential until ruled out to improve patient outcomes as much as possible. Obtaining blood pressure control is imperative to reducing maternal and fetal mortality. Preeclampsia is similarly serious, and early diagnosis is essential for adequate management of the condition until delivery can occur.
Highlights
Pheochromocytoma, a neuroendocrine tumor that secretes catecholamines, can present with episodic sweating, diaphoresis, headaches, and hypertension, as well as cardiac and pulmonary involvement. It must be differentiated from preeclampsia, a leading cause of maternal mortality in the developed world, which can present with hypertension and multiorgan involvement
Preeclampsia is serious, and early diagnosis is essential for adequate management of the condition until delivery can occur. [Clin Pract Cases Emerg Med. 2021;5(4):394–398.]
Diagnosis requires biochemical confirmation with urine or plasma fractionated metanephrines.[6]. This is followed by radiologic studies to locate the tumor and resect if anatomically feasible.[6]. It must be differentiated from preeclampsia, a condition with a very different etiology, that can lead to multiorgan system involvement and is a leading cause of maternal mortality in the developed world.[7]
Summary
Pheochromocytoma, a neuroendocrine tumor that secretes catecholamines, can present with episodic sweating, diaphoresis, headaches, and hypertension, as well as cardiac and pulmonary involvement. It must be differentiated from preeclampsia, a leading cause of maternal mortality in the developed world, which can present with hypertension and multiorgan involvement. Both conditions require early diagnosis and treatment to reduce maternal and fetal morbidity and mortality. The patient acutely decompensated during the course of evaluation. She suffered pregnancy loss and multiorgan failure requiring percutaneous heart pump placement and extracorporeal membrane oxygenation therapy for support before fully recovering. The adrenal mass was confirmed to be a pheochromocytoma after excision and contributed to the development of hypertensive emergency with multiorgan failure
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