Pheochromocytoma In Pregnancy

Year 2020, Volume: 42 Issue: 5, 584 - 587, 15.09.2020

Elif Sevil Alagüney Fatma Belgin Efe Funda Canaz Bartu Badak Goknur Yorulmaz

https://doi.org/10.20515/otd.634238

Abstract

Pheochromocytoma is a neuro-endocrine tumor which secretes catecholamine. It is rare in pregnancy. Misdiagnosis as gestational hypertension or preeclampsia may cause delays in diagnosis. We aimed to discuss a case of pheochromocytoma during pregnancy presenting with hypertension. A 27-year-old female patient with 15-weeks of pregnancy was found to have a 45x55 millimeter mass on the left adrenal gland while she was complaining left side pain. Physical examination revealed hypertension. 24-hour urine catecholamine levels were elevated. Abdominal MRI was consistent with pheochromocytoma. After appropriate preparation, laparoscopic adrenalectomy was performed for the left adrenal gland in second trimester. Catecholamine levels decreased after the operation. The pathology was consistent with pheochromocytoma. The patient delivered a baby by cesarean section at 37th gestational week. Pheochromocytoma during pregnancy is a rare but important cause of morbidity and mortality for mother and fetus. Therefore, it should be considered in the differential diagnosis especially in pregnant women presenting with hypertension in first trimester.

Keywords

pregnancy, hypertension, pheochromocytoma

Gebelikte Feokromositoma

Abstract

Feokromositoma, katekolamin salgılayan bir nöro-endokrin tümördür. Hamilelikte nadir görülür. Yanlışlıklar gestasyonel hipertansiyon veya preeklampsi tanısı konulması feokromositoma tanısında gecikmelere neden olabilir. Bu çalışmada, gebelikte hipertansiyon ile başvuran ve feokromositoma tanısı konulan bir olguyu tartışmayı amaçladık. Sol yan ağrısı şikayeti olan 27 yaşında onbeş haftalık gebe hastada sol adrenal bezde 45x55 milimetre kitle tespit edilmiştir. Fizik muayenede hipertansiyon saptanan hastanın 24 saatlik idrar katekolamin düzeyleri yüksek tespit edildi. Abdominal MR feokromositoma ile uyumlu saptandı. Preoperatif hazırlığın ardından ikinci trimesterde sol adrenal beze laparoskopik adrenalektomi uygulandı. Ameliyattan sonra katekolamin düzeyleri düştü. Patoloji feokromositoma ile uyumluydu. 37. gebelik haftasında bebek sezaryen ile doğdu. Hamilelik sırasında feokromositoma nadirdir fakat anne ve fetus için önemli bir morbidite ve mortalite nedenidir. Bu nedenle, özellikle ilk trimesterde hipertansiyon ile başvuran gebelerde ayırıcı tanıda düşünülmelidir.

Keywords

gebelik, hipertansiyon, feokromositoma, katekolamin

References

• REFERANS 1.Yulia A, Seetho IW, Ramineni A, Jaiyesimi RAK (2016) Pheochromocytoma inPregnancy: A Review of the Literature. Obstet Gynecol Cases Rev 3:096.
• REFERANS 2. Alface MM, Moniz P, Jesus S, Fonseca C (2015) Pheochromocytoma: clinicalreview based on a rare case in adolescence. BMJ case reports.
• REFERANS 3. Jacques W M Lenders (2012) Pheochromocytoma and pregnancy: a deceptive connection. European Journal of Endocrinology 166 143–150
• REFERANS 4. Ahlawat SK, Jain S, Kumari S, Varma S, Sharma BK (1999) Pheochromocytoma associated with pregnancy: case report and review of the literature. Obstet Gynecol Surv 54: 728-737.
• REFERANS 5. Oliva R, Angelos P, Kaplan E, Bakris G (2010) Pheochromocytoma in pregnancy: a case series and review. Hypertension 55: 600-606.
• REFERANS 6. Mohamed Ismail NA, Abd Rahman R, Abd Wahab N, Muhammad R, Nor Azmi K (2012) Pheochromocytoma and pregnancy: a difficult and dangerous ordeal. Malays J Med Sci 19: 65-68.
• REFERANS 7. Huddle KR, Nagar A (1999) Phaeochromocytoma in pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology 39: 203-206.
• REFERANS 8. Mohamed Ismail NA, Abd Rahman R, Abd Wahab N, Muhammad R, Nor Azmi K. Pheochromocytoma and pregnancy: a difficult and dangerous ordeal. Malays J Med Sci. 2012;19(1):65–68.
• REFERANS 9. Sarathi V, Lila AR, Bandgar TR, Menon PS, Shah NS. Pheochromocytoma and pregnancy: A rare but dangerous combination. Endocr Pract. 2010;16(2):300–309.
• REFERANS 10. Newell K, Prinz RA, Braithwaite S, Brooks M (1988) Pheochromocytoma crisis. Am J Hypertens 1: 189S-191S.
• REFERANS 11.Whitelaw BC, Prague JK, Mustafa OG, Schulte KM, Hopkins PA, et al. (2014) Phaeochromocytoma [corrected] crisis. Clin Endocrinol (Oxf) 80: 13-22.
• REFERANS 12.Schurmeyer TH, Engeroff B, Dralle H, von zur Muhlen A (1997) Cardiological effects of catecholamine-secreting tumours. Eur J Clin Invest 27: 189-195.
• REFERANS 13.Liao WB, Liu CF, Chiang CW, Kung CT, Lee CW (2000) Cardiovascular manifestations of pheochromocytoma. Am J Emerg Med 18: 622-625
• REFERANS 14. Lenders JW (2012) Pheochromocytoma and pregnancy: a deceptive connection. Eur J Endocrinol 166: 143-150
• REFERANS 15. Natrajan PG, McGarrigle HH, Lawrence DM, Lachelin GC (1982) Plasma noradrenaline and adrenaline levels in normal pregnancy and in pregnancyinduced hypertension. Br J Obstet Gynaecol 89: 1041-1045.
• REFERANS 16. Hotu C, Harman R, Cutfield R, Hodges N, Taylor E, et al. (2015) Laparoscopic adrenalectomy for phaeochromocytoma: a case series. N Z Med J 128: 35-41.
• REFERANS 17. Grossman A, Pacak K, Sawka A, Lenders JW, Harlander D, Peaston RT, Reznek R, Sisson J & Eisenhofer G. Biochemical diagnosis and localization of phaeochromocytoma: can we reach a consensus? Annals of the New York Academy of Sciences 2006 1073 332–347.
• REFERANS 18. Burgess GE III. Alpha blockade and surgical intervention of pheochromocytoma in pregnancy. Obstetrics and Gynecology 1979 53 266–270.
• REFERANS 19. Lansdown A, Rees DA (2011) Endocrine oncology in pregnancy. Best Pract Res Clin Endocrinol Metab 25: 911-926.