Pregnancy and phaeochromocytoma/paraganglioma: clinical clues affecting diagnosis and outcome - a systematic review.

Abstract

Phaeochromocytoma and paraganglioma (PPGL) in pregnancy, if not diagnosed antepartum, pose a high risk for mother and child. To examine the clinical clues of antepartum and postpartum/postmortem diagnosis of PPGL. Case reports on PPGL in pregnancy published between 1 January 1988 and 30 June 2019 in English, German, Dutch or French. Case reports containing a predefined minimum of clinical data on PPGL and pregnancy. Two authors independently performed data extraction and assessed data quality. We calculated odds ratios (OR) (with 95% confidence intervals) and used uni- and multivariable logistic regression analysis. Maternal and fetal/neonatal mortalities were 9.0% (18/200) and 14.2% (29/204), respectively. Maternal mortality was 42-fold higher with PPGL diagnosed postpartum/postmortem (17/58; 29.3%) than antepartum (1/142; 0.7%) (adjusted OR 45.9, 95% CI 5.67-370, P=0.0003). Offspring mortality was 2.6-fold higher with PPGL diagnosed postpartum/postmortem than antepartum (OR 3.1, 95% CI 1.38-6.91, P=0.0044). Hypertension at admission (OR 2.29, 95% CI 1.12-4.68, P=0.022), sweating (OR 3.14, 95% CI 1.29-7.63, P=0.014) and a history of PPGL, a known PPGL-associated gene mutation or adrenal mass (OR 8.87, 95% CI 1.89-41.64, P=0.0056) were independent factors of antepartum diagnosis. Acute onset of symptoms (OR 8.49, 95% CI 3.52-20.5, P<0.0001), initial diagnosis of pre-eclampsia (OR 6.34, 95% CI 2.60-15.5, P<0.0001), admission for obstetric care (OR 10.71, 95% CI 2.70-42.45, P=0.0007) and maternal tachycardia (OR 2.72, 95% CI 1.26-5.85, P=0.011) were independent factors of postpartum diagnosis. Several clinical clues can assist clinicians in considering an antenatal diagnosis of PPGL in pregnancy, thus potentially improving outcome. Systematic review of 204 pregnant patients with phaeochromocytoma identified clinical clues for a timely antepartum diagnosis.