Diagnosis and management of pheochromocytoma in pregnancy / 中华泌尿外科杂志

ABSTRACT

Objective To discuss the diagnosis and management of pheochromocytoma in pregnancy. Methods Three cases of pheochromocytoma in pregnancy were managed from 2007- 2009.Case 1, a 41-year-old woman presented with paroxysmal hypertension during 27+1 weeks' gestation.The accompanied symptoms included dizziness, palpitation and sweating. Both B ultrasound and MRI revealed a right adrenal tumor about 7 cm in diameter. The 24-hour catecholamine was higher than normal. A diagnosis of right adrenal pheochromocytoma was made. Case 2, a 28-year-old woman presented with hypertension during 12+4 weeks' gestation. B ultrasound showed a right adrenal tumor about 5 cm in diameter. The 24-hour catecholamine was higher than normal. 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 was higher than normal. The diagnosis of bilateral adrenal pheochromocytomas was made. Results The first patient delivered a healthy female infant through cesarean section at 32 weeks' gestation. Laparoscopic resection of right adrenal pheochromocytoma was successfully performed at the same time. Both the second and third patients had elective abortion for fear of fetotoxicity. Case 2 accepted laparoscopic resection of right adrenal pheochromocytoma after 4 weeks' medical preparation. Case 3 rejected surgery. The histopathological findings proved pheochromocytoma in case 1 and case 2. Conclusions Pheochromocytoma should be included in the defferential diagnosis in hypertension occurring during pregnancy especially in the following situationshypertension during early pregnancy; paroxymal hypertension accompanied by headache, palpitation and sweating; hypertension does not relieve after delivery. Early diagnosis and management with medical treatment followed by surgical removal usually results in good maternal and fetal outcomes. The second trimester is good timing of surgical management. Laparoscopic removal of pheochromocytoma is safe in pregnancy.