Abstract

Pheochromocytoma occurs with a frequency estimated at 2-7 per 100 000 pregnant women. Unrecognized, and thus untreated pheochromocytoma is associated with very high (40-50%) maternal and fetal mortality. Pheochromocytoma occurs sporadically or as a family trait. Its presence should be suspected in women with paroxysmal or established hypertension, especially before the 20th week of pregnancy, accompanied by headaches and palpitations, and excessive sweating, muscle tremors, vomiting, anxiety, vasomotor disturbances and blurred vision. The variety of clinical presentations and rarity are the cause of not including the disease in differential diagnosis of hypertension in pregnancy. Biochemical tests are essential in the diagnosis of pheochromocytoma, and involving the assessment of methoxycatecholamine urinary excretion. The second step in the diagnostics is magnetic resonance imaging of adrenal glands. Adrenalectomy is the treatment of choice for pheochromocytoma with adrenal location, which depends on the timing of the tumor diagnosis. Conservative treatment for 10-14 days with pharmacological blockade of alpha-adrenergic receptors should precede the surgery. Early diagnosis and properly planned treatment of pheochromocytoma significantly reduces the risk to the mother and fetus.

References

• 1. Ahlawat S.K., Jain S., Kumari S., Varma S., Sharma B.K.: Phaeochromocytomaassociated with pregnancy: case report and reviewof the literature. Obstet. Gynecol. Surv., 1999; 54: 728-737
  Google Scholar
• 2. Barzel U.S., Bar-Ilan Z., Rumney G., Lazebnik Y., Eckerling B.,Devries A.: Pheochromocytoma and pregnancy: simultaneous deliveryby cesarean section and resection of tumor. Am. J. Obstet.Gynecol., 1964; 89: 519-527
  Google Scholar
• 3. Benowitz N.L.: Pheochromocytoma. Adv. Intern. Med. 1990; 35: 195-219
  Google Scholar
• 4. Biggar M.A., Lennard T.W.: Systematic review of phaeochromocytomain pregnancy. Br. J. Surg., 2013; 100: 182-190
  Google Scholar
• 5. Carvalho M.R,. Dias T., Rodrigues A., Machado A.P., Esteves R., doCarmo I.: Alpha blockade with doxazosin in pheochromocytoma -report of three cases. Rev. Port. Cardiol., 2010; 29: 299-308
  Google Scholar
• 6. Chan A.S., Ananthanarayan C., Rolbin S.H.: Alternating nitroglycerinand syntocinon to facilitate uterine exploration and removal ofan adherent placenta. Can. J. Anaesth., 1995; 42: 335-337
  Google Scholar
• 7. Daly P., Landsberg L.: Phaeocromocytoma: diagnosis and management.Baillieres Clin. Endocrinol. Metab., 1992; 6: 143-166
  Google Scholar
• 8. Freier D.T., Thompson N.W.: Pheochromocytoma and pregnancy:the epitome of high risk. Surgery, 1993; 114: 1148-1152
  Google Scholar
• 9. Gifford R.W.Jr., Kvale W.F., Maher F.T., Roth G.M., Priestley J.T.:Clinical features, diagnosis and treatment of pheochromocytoma:A review of 76 cases. Mayo Clin. Proc., 1964; 39: 281-302
  Google Scholar
• 10. Glinicki P., Jeske W., Bednarek-Papierska L., Kasperlik-ZałuskaA., Rosłonowska E., Gietka-Czernel M., Zgliczyński W.: ChromograninA (CgA) in adrenal tumours. Endokrynol. Pol., 2013;64: 358-362
  Google Scholar
• 11. Gómez R.R., Osborne B.M., Ordoñez N.G., Mackay B.: Pheochromocytoma.Ultrastruct. Pathol., 1991; 15: 557-562
  Google Scholar
• 12. Hudsmith J.G., Thomas C.E., Browne D.A.: Undiagnosed phaeochromocytomamimicking severe preeclampsia in a pregnant womanat term. Int. J. Obstet. Anesth., 2006; 15: 240-245
  Google Scholar
• 13. Iseri L.T.: Magnesium and cardiac arrhythmias. Magnesium,1986; 5: 111-126
  Google Scholar
• 14. Januszewicz W., Prejbisz A., Januszewicz A., Pęczkowska M.: Guzchromochłonny – choroba o wielu obliczach. Arterial Hypertension,2002; 6: 217-227
  Google Scholar
• 15. Junglee N., Harries S.E., Davies N., Scott-Coombes D., ScanlonM.F., Rees D.A.: Pheochromocytoma in pregnancy: when is operativeintervention indicated? J. Womens Health, 2007; 16: 1362-1365
  Google Scholar
• 16. Kim J., Reutrakul S., Davis D.B., Kaplan E.L., Refetoff S.: Multipleendocrineneoplasia 2A syndrome presenting as peripartumcardiomyopathy due to catecholamine excess. Eur. J. Endocrinol.,2004; 151: 771-777
  Google Scholar
• 17. Kim P.T., Kreisman S.H., Vaughn R., Panton O.N.: Laparoscopicadrenalectomy for pheochromocytoma in pregnancy. Can. J. Surg.,2006; 49: 62-63
  Google Scholar
• 18. Lenders J.W.: Pheochromocytoma and pregnancy: a deceptiveconnection. Eur. J. Endocrinol., 2012; 166: 143-150
  Google Scholar
• 19. Lenders J.W., Eisenhofer G., Mannelli M., Pacak K.: Phaeochromocytoma.Lancet, 2005; 366: 665-675
  Google Scholar
• 20. Lenders J.W., Pacak K., Walther M.M., Linehan W.M., MannelliM., Friberg P., Keiser H.R., Goldstein D.S., Eisenhofer G.: Biochemicaldiagnosis of pheochromocytoma: Which test is best? JAMA, 2002;287: 1427-1434
  Google Scholar
• 21. Mallat J., Pironkov A., Destandau M.S., Tavernier B.: Systolicpressure variation can guide fluid therapy during pheochromocytomasurgery. Can. J. Anaesth., 2003; 10: 998-1003
  Google Scholar
• 22. Mannelli M., Bemporad D.: Diagnosis and management of pheochromocytomaduring pregnancy. J. Endocrinol. Invest., 2002; 25: 567-571
  Google Scholar
• 23. Mastrogiannis D.S., Whiteman V.E., Mamopoulos M., SalamehW.A.: Acute endocrinopathies during pregnancy. Clin. Obstet. Gynecol.1994; 37: 78-92
  Google Scholar
• 24. Miura Y., Yoshinaga K.: Doxazosin: a newly developed, selectivealpha 1 inhibitor in the management of patients with pheochromocytoma.Am. Heart. J., 1988; 116: 1785-1789
  Google Scholar
• 25. Nakajima Y., Masaoka N., Sodeyama M., Tsuduki Y., Sakai M.:Pheochromocytoma-related cardiomyopathy during the antepartumperiod in a preterm pregnant woman. J. Obstet. Gynaecol. Res.,2011; 37: 908-911
  Google Scholar
• 26. Nanda A.S., Feldman A., Liang C.S.: Acute reversal of pheochromocytoma-inducedcatecholamine cardiomyopathy. Clin. Cardiol.,1995; 18: 421-423
  Google Scholar
• 27. Poprawski G., Wender-Ożegowska E., Zawiejska A., Brazert J.:Modern methods of early screening for preeclampsia and pregnancy-inducedhypertension – a review. Ginekol. Pol., 2012; 83: 688-693
  Google Scholar
• 28. Sardesai S.H., Mourant A.J., Sivathandon Y., Farrow R., GibbonsD.O.: Phaeochromocytoma and catecholamine induced cardiomyopathypresenting as heart failure. Br. Heart. J., 1990; 63: 234-237
  Google Scholar
• 29. Satani O., Katsuragi M., Hano T., Tomobuchi Y., Arita M., NishioI.: Pheochromocytoma-related myocardial damage following delivery.Hypertens. Res., 1996; 19: 291-293
  Google Scholar

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