51
|
Shah S, Edwards L, Robinson A, Crosthwaite A, Houlihan C, Paizis K. A rare cause of hypertension in pregnancy: Phaeochromocytoma. Obstet Med 2017; 10:83-84. [DOI: 10.1177/1753495x16669995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/26/2016] [Indexed: 12/25/2022] Open
Abstract
A 26-year-old primigravida at 35 weeks’ gestation was transferred to our institution from a regional hospital for management of presumed preeclampsia. Due to the labile nature of her hypertension, further investigation was undertaken which revealed a right-sided phaeochromocytoma. Alpha blockade was commenced, and an uncomplicated elective caesarean delivery was performed at 38 weeks’ gestation under spinal anaesthetic. The patient underwent an elective right laparoscopic adrenalectomy six weeks post-partum. This case highlights the importance of investigating young women for secondary causes of hypertension to avoid mislabelling as essential or gestational hypertension.
Collapse
Affiliation(s)
- Sonali Shah
- Department of Endocrinology, Austin and Mercy Health, Melbourne, Australia
| | | | - Andrew Robinson
- Department of Anaesthesia, Mercy Health, Melbourne, Australia
| | - Amy Crosthwaite
- Department of Renal, Austin and Mercy Health, Melbourne, Australia
| | - Christine Houlihan
- Department of Endocrinology, Austin and Mercy Health, Melbourne, Australia
| | - Kathy Paizis
- Department of Renal, Austin and Mercy Health, Melbourne, Australia
| |
Collapse
|
52
|
Remón-Ruiz P, Aliaga-Verdugo A, Guerrero-Vázquez R. Pheochromocytoma in neurofibromatosis type 1 during pregnancy. Gynecol Endocrinol 2017; 33:93-95. [PMID: 27908211 DOI: 10.1080/09513590.2016.1254181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pregnant women with neurofibromatosis type 1 (NF-1) have increased complications during gestation, including hypertensive disorders that are sometimes caused by pheochromocytoma. Pheochromocytoma is an extremely rare condition during pregnancy, and the main clinical manifestation is hypertension. If not properly treated, pheochromocytoma has high maternal and fetal mortality rates. Early recognition and adequate clinical management before delivery have led to better outcomes in the last few decades. Despite the association of NF-1 and pheochromocytoma, there are few clinical reports of these two conditions in pregnant patients. We present a rare case of pheochromocytoma diagnosed during pregnancy in a patient with NF-1, and we describe the treatment and the obstetric and fetal outcomes. We also review other medical conditions related to NF-1 that complicated this patient's pregnancy.
Collapse
Affiliation(s)
- Pablo Remón-Ruiz
- a Department of Endocrinology and Nutrition , Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla , Seville , Spain
| | - Alberto Aliaga-Verdugo
- a Department of Endocrinology and Nutrition , Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla , Seville , Spain
| | - Raquel Guerrero-Vázquez
- a Department of Endocrinology and Nutrition , Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla , Seville , Spain
| |
Collapse
|
53
|
Extracorporeal Membrane Oxygenation for Treatment of Acute Inverted Takotsubo-Like Cardiomyopathy From Hemorrhagic Pheochromocytoma in Late Pregnancy. ACTA ACUST UNITED AC 2017; 7:196-199. [PMID: 27607406 DOI: 10.1213/xaa.0000000000000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the first case of a pregnant woman presenting with an acute inverted takotsubo-like cardiomyopathy caused by a postpartum diagnosed hemorrhagic pheochromocytoma, successfully treated with percutaneous venoarterial extracorporeal membrane oxygenation (va-ECMO). During admission, an emergency cesarean delivery had to be performed. The fetus needed resuscitation for 5 minutes. The mother was successfully resuscitated and treated with percutaneous va-ECMO for 7 days. Despite advances in diagnostic techniques during the past decade, in many cases, pheochromocytoma in pregnancy is still missed. This results in a maternal and fetal mortality rate of up to 30% in both.
Collapse
|
54
|
From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia. Case Rep Anesthesiol 2017; 2017:5495808. [PMID: 28197344 PMCID: PMC5286480 DOI: 10.1155/2017/5495808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022] Open
Abstract
Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features. Her initial presentation in hypertensive crisis with other symptoms led to diagnostic workup for secondary causes of hypertension and led to eventual diagnosis of paraganglioma. Obtaining this diagnosis prior to delivery was essential, as this led to prompt multidisciplinary care, changed the course of her clinical management, and ultimately enabled good maternal and fetal outcomes. This case highlights the importance of maintaining a high index of suspicion for secondary causes of hypertension and in obstetric patients and providing timely multidisciplinary care.
Collapse
|
55
|
Zhou X, Zhao C, Feng X, Samanta A, Lin YN, Chen J, Dai X, Hong X, Xie Q, Huang W. Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis. ESC Heart Fail 2016; 3:282-287. [PMID: 27867530 PMCID: PMC5107978 DOI: 10.1002/ehf2.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
Pheochromocytoma associated with pregnancy is not common. Caesarean section may induce pheochromocytoma crisis, resulting in a lethal condition. The clinical picture of pheochromocytoma crisis is extremely variable. In this report, we describe a case of severe pheochromocytoma crisis induced by caesarean section presenting with hyperpyrexia, haemodynamic collapse, muscle weakness, heart failure, and acute kidney injury. Furthermore, we report that the muscle weakness was a manifestation of rhabdomyolysis, resulting from the pheochromocytoma crisis. Standard medical therapy failed to halt the patient's rapidly deteriorating condition. Continuous renal replacement therapy removed catecholamines from the circulation, resulting in improvement of haemodynamics and abrogation of rhabdomyolysis.
Collapse
Affiliation(s)
- Xi Zhou
- Department of Cardiac Care UnitThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina; Department of Cardiology, The Key Lab of Cardiovascular Disease of WenzhouThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Chuhuan Zhao
- Department of Cardiac Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Xiafei Feng
- Department of Cardiac Care UnitThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina; Department of Cardiology, The Key Lab of Cardiovascular Disease of WenzhouThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Anweshan Samanta
- Institute of Cardiovascular Research University of Kansas Medical Center Kansas City KS USA
| | - Yi Nuo Lin
- Department of Cardiology, The Key Lab of Cardiovascular Disease of Wenzhou The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Jun Chen
- Department of Cardiac Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Xiaochun Dai
- Department of Cardiac Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Xia Hong
- Department of Cardiac Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Qiangli Xie
- Department of Cardiac Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Weijian Huang
- Department of Cardiac Care UnitThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina; Department of Cardiology, The Key Lab of Cardiovascular Disease of WenzhouThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| |
Collapse
|
56
|
Mita K, Tsugita K, Yasuda Y, Matsuki Y, Obata Y, Matsuki Y, Kamisawa S, Shigemi K. A successfully treated case of cardiac arrest after Caesarean section complicated by pheochromocytoma crisis and amniotic fluid embolism. J Anesth 2016; 31:140-143. [PMID: 27832332 DOI: 10.1007/s00540-016-2281-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022]
Abstract
Both pheochromocytoma and amniotic fluid embolism (AFE) are important causes of maternal mortality. We present a case of a 29-year-old woman who developed cardiac arrest after Caesarean section, complicated by both pheochromocytoma crisis and AFE. After resuscitation, the patient developed multiple organ dysfunction, rhabdomyolysis and disseminated intravascular coagulation (DIC). After institution of multidisciplinary interventions (including the use of an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous hemodiafiltration, and neuroprotective therapeutic hypothermia) the patient made a full recovery without any apparent neurological deficit.
Collapse
Affiliation(s)
- Kenichiro Mita
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Kayo Tsugita
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Yoshikazu Yasuda
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan.
| | - Yasunari Matsuki
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Yurie Obata
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Yuka Matsuki
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Seiichi Kamisawa
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Kenji Shigemi
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| |
Collapse
|
57
|
Tingi E, Kyriacou A, Verghese L. Recurrence of phaeochromocytoma in pregnancy in a patient with multiple endocrine neoplasia 2A: a case report and review of literature. Gynecol Endocrinol 2016; 32:875-880. [PMID: 27808580 DOI: 10.1080/09513590.2016.1236242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited condition with a prevalence of one in 40 000 individuals. It causes the development of tumours in endocrine glands, such as medullary thyroid cancer, pheochromocytomas, as well as primary hyperparathyroidism. MEN 2A in pregnancy is very rare with only 29 cases reported in the literature. The presence of pheochromocytoma is a rare cause of hypertension during pregnancy with an incidence of 0.007% of all pregnancies. This has severe implications on both mother and the foetus. This case report describes a 22-year-old nulliparous Caucasian woman with known MEN2A syndrome, who underwent thyroidectomy for medullary thyroid carcinoma in childhood and excision of left sided pheochromocytoma at the age of 19. She was found to have a recurrence of pheochromocytoma in the right adrenal gland during pregnancy at 16 weeks of gestation and was oddly normotensive. Catecholamine effects were blocked with phenoxybenzamine and she delivered by an uneventful elective caesarean section at 36 weeks gestation. She underwent a laparoscopic right adrenalectomy six weeks postpartum, followed by lifelong corticosteroid replacement.
Collapse
Affiliation(s)
- Efterpi Tingi
- a Specialist Registrar in Obstetrics and Gynaecology, St. Mary's Hospital , Manchester , UK
| | - Angelos Kyriacou
- b Consultant in Endocrinology and Diabetes, Salford Royal Hospital , Manchester , UK
- c Diabetes & Metabolism, Centre of Endocrinology , Limassol , Cyprus , and
| | - Lynda Verghese
- d Consultant in Obstetrics and Gynaecology, Wrexham Maelor Hospital , Wales , UK
| |
Collapse
|
58
|
Yasui M, Hattori Y, Uemura K, Ishida H, Teranishi JI, Yumura Y, Miyoshi Y, Kondo K, Uemura H. [PHEOCHROMOCYTOMA DURING PREGNANCY-2 CASE REPORTS]. Nihon Hinyokika Gakkai Zasshi 2016; 107:245-250. [PMID: 29070738 DOI: 10.5980/jpnjurol.107.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
(Introduction) A pheochromocytoma diagnosed during pregnancy is rare, and also its fetal and maternal mortality is high if undiagnosed. We report two cases with successful pregnancy outcome with pheochromocytoma. (Case 1) A 31-years-old previously healthy woman presented at 19 week period of gestation with high blood pressure. High urine catecholamine level and a left adrenal mass recognized by magnetic resonance imaging (MRI) confirmed adrenal pheochromocytoma. The patient had good blood pressure control after we started doxazosin 4 mg daily, and Caesarean section was performed at 35 week period of gestation. Two months after delivery, laparoscopic adrenalectomy was performed and she was discharged in the absence of hypertension. (Case 2) A 31-years-old previously healthy woman presented at 29 week period of gestation with exacerbation of headache and palpitation. High urine catecholamine level and a mass recognized close to the inferior vena cava by MRI confirmed extraadrenal pheochromocytoma. The patient had good blood pressure after we started doxazosin 4 mg daily and labetalol hydrochloride 200 mg daily. Caesarean section was performed at 35 week period of gestation. One month after delivery, laparotomic resection of the tumor was performed. Seven years later, hypertension reoccurred and there was an extraadrenal pheochromocytoma recurrence. We had a laparotomic resection for the recurrent tumor, and now she is in the absence of hypertension. (Conclusion) Pheochromocytoma should be considered as a differential diagnosis in a case of high blood pressure occurred during pregnancy. Early detection and appropriate treatment is crucial to reduce fetal and maternal mortality.
Collapse
Affiliation(s)
- Masato Yasui
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yusuke Hattori
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Koichi Uemura
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Hiroaki Ishida
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Jun-Ichi Teranishi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yasushi Yumura
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yasuhide Miyoshi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Keiichi Kondo
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Hiroji Uemura
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| |
Collapse
|
59
|
Imitators of preeclampsia: A review. Pregnancy Hypertens 2016; 6:1-9. [DOI: 10.1016/j.preghy.2016.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
|
60
|
Riester A, Weismann D, Quinkler M, Lichtenauer UD, Sommerey S, Halbritter R, Penning R, Spitzweg C, Schopohl J, Beuschlein F, Reincke M. Life-threatening events in patients with pheochromocytoma. Eur J Endocrinol 2015; 173:757-64. [PMID: 26346138 DOI: 10.1530/eje-15-0483] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pheochromocytomas are rare chromaffin cell-derived tumors causing paroxysmal episodes of headache, palpitation, sweating and hypertension. Life-threatening complications have been described in case reports and small series. Systematic analyses are not available. We took an opportunity of a large series to make a survey. DESIGN AND METHODS We analyzed records of patients diagnosed with pheochromocytomas in three geographically spread German referral centers between 2003 and 2012 (n=135). RESULTS Eleven percent of the patients (ten women, five men) required in-hospital treatment on intensive care units (ICUs) due to complications caused by unsuspected pheochromocytomas. The main reasons for ICU admission were acute catecholamine induced Tako-Tsubo cardiomyopathy (n=4), myocardial infarction (n=2), acute pulmonary edema (n=2), cerebrovascular stroke (n=2), ischemic ileus (n=1), acute renal failure (n=2), and multi organ failure (n=1). One patient required extracorporeal membrane oxygenation due to a hypertensive crisis with lung edema occurring during delivery (n=1). Two patients died of refractory shock and pheochromocytomas were found postmortem. Two patients were treated by emergency surgery. Compared to pheochromocytoma patients without life-threatening events (n=120), patients with complications had a significant larger maximal tumor diameter (7.0 vs 4.5 cm, P<0.01), higher levels of catecholamines (20- vs ninefold upper limit of normal, P<0.01), and tended to be younger (42 vs 51 years, P=0.05). CONCLUSION Although pheochromocytomas are rare, they are likely to be associated with a life-threatening situation. Clinicians have to be aware of these situations and perform a timely diagnosis.
Collapse
Affiliation(s)
- Anna Riester
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Dirk Weismann
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marcus Quinkler
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Urs D Lichtenauer
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sandra Sommerey
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Roland Halbritter
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Randolph Penning
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Christine Spitzweg
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| |
Collapse
|
61
|
Prete A, Paragliola RM, Salvatori R, Corsello SM. MANAGEMENT OF CATECHOLAMINE-SECRETING TUMORS IN PREGNANCY: A REVIEW. Endocr Pract 2015; 22:357-70. [PMID: 26536138 DOI: 10.4158/ep151009.ra] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Catecholamine-secreting tumors (pheochromocytomas and paragangliomas) presenting during pregnancy are extremely rare, but they can be fatal to both mother and fetus. Recent discoveries in the genetic background of these tumors are expected to address an increasing number of at-risk women to prenatal diagnosis. METHODS The literature was reviewed in order to provide clinicians with a practical and updated guide on how to manage this life-threatening condition. RESULTS The clinical presentation of catecholamine-secreting tumors can be deceptive and mimic common disorders of pregnancy. Silent catecholamine-secreting tumors can become evident during pregnancy, and hypertension cannot be considered a hallmark for this condition: some women may be normotensive or develop orthostatic hypotension. Biochemical screening includes measurement of plasma free metanephrines or urinary fractioned metanephrines. Measurement of catecholamines, dopamine, and methoxytyramine can provide further information on tumor biology, location, and prognosis. Diagnostic imaging is limited, and medical treatment requires a cautious balance between hemodynamic control and effects on the fetoplacental unit. Several genes have been associated with syndromes including catecholamine-secreting tumors, and positive genetic testing can correlate with tumor behavior. Timing and modalities for tumor removal and delivery, including anesthetic management, depend on gestational age, maternal and fetal wellbeing, control of catecholamine excess, suspicion of multiple or malignant disease, and surgical accessibility to the tumor. CONCLUSION A timely diagnosis and a multidisciplinary approach are the keys to improve pregnancy outcomes in patients with a catecholamine-secreting tumor; each case should be managed in a tertiary referral center.
Collapse
|
62
|
Pheochromocytoma Presenting as Partial HELLP Syndrome. Case Rep Obstet Gynecol 2015; 2015:294326. [PMID: 26351602 PMCID: PMC4553187 DOI: 10.1155/2015/294326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/03/2015] [Accepted: 08/11/2015] [Indexed: 12/03/2022] Open
Abstract
Diagnosis of pheochromocytoma in partial HELLP syndrome is extremely rare. We report a case of a 25-year-old multigravida woman at 30 weeks of gestation who presented with clinical features consistent with partial HELLP syndrome. Her symptoms were not controlled by pharmacologic therapy, and the patient underwent urgent cesarean section. The patient gave birth to a viable baby, but she sustained an episode of ventricular fibrillation intraoperatively that did not result in any long-term sequelae. The patient's symptoms persisted postoperatively and work-up for secondary etiologies of hypertension demonstrated a right adrenal pheochromocytoma. Following resection, the patient's signs and symptoms resolved, and her lab tests normalized.
Collapse
|
63
|
Morton A. Primary aldosteronism and pregnancy. Pregnancy Hypertens 2015; 5:259-62. [PMID: 26597737 DOI: 10.1016/j.preghy.2015.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022]
Abstract
Primary aldosteronism is the most common cause of secondary hypertension. Less than 50 cases of pregnancy in women with primary aldosteronism have been reported, suggesting the disorder is significantly underdiagnosed in confinement. Accurate diagnosis is complicated by physiological changes in the renin-angiotensin-aldosterone axis in pregnancy, leading to a risk of false negative results on screening tests. The course of primary aldosteronism during pregnancy is highly variable, although overall it is associated with a very high risk of fetal and maternal morbidity and mortality. The optimal management of primary aldosteronism during pregnancy is unclear, with uncertainty regarding the safety of mineralocorticoid antagonists and amiloride, their relative efficacy compared with the antihypertensive medications commonly used during pregnancy, and as to whether prognosis is improved by laparoscopic adrenalectomy where an adrenal adenoma can be demonstrated.
Collapse
Affiliation(s)
- Adam Morton
- Mater Health Services, Raymond Tce, South Brisbane, QLD 4101, Australia.
| |
Collapse
|
64
|
|
65
|
Dealing with Pheochromocytoma during the First Trimester of Pregnancy. Case Rep Obstet Gynecol 2015; 2015:439127. [PMID: 25838955 PMCID: PMC4369956 DOI: 10.1155/2015/439127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.
Collapse
|
66
|
Berkel AV, Lenders JWM. Pheochromocytoma. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014. [DOI: 10.2217/ije.14.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytoma and paraganglioma are catecholamine-producing tumors that are associated with substantial serious morbidity and mortality. A carefully taken medical history and early consideration of such tumors are key for early diagnosis and treatment. The biochemical diagnosis should include measurements of metanephrines in either plasma or urine. In addition to anatomical imaging, sensitive functional imaging modalities offer extra benefit for most patients in locating the tumor and eventual metastases. In at least 30% of all patients with a pheochromocytoma/paraganglioma, an underlying germline is responsible for tumor development and genetic testing should be considered in all patients. Current treatment options for malignant pheochromocytoma/paraganglioma are still very modest. New developments in the therapeutic armamentarium may improve the prospect for these patients.
Collapse
Affiliation(s)
- Anouk van Berkel
- Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 8, 6525 GA, Nijmegen, The Netherlands
| | - Jacques WM Lenders
- Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 8, 6525 GA, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| |
Collapse
|
67
|
|
68
|
Muzannara MA, Tawfeeq N, Nasir M, Al Harbi MK, Geldhof G, Dimitriou V. Vaginal delivery in a patient with pheochromocytoma, medullary thyroid cancer, and primary hyperparathyroidism (multiple endocrine neoplasia type 2A, Sipple's syndrome). Saudi J Anaesth 2014; 8:437-9. [PMID: 25191209 PMCID: PMC4141407 DOI: 10.4103/1658-354x.136652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Multiple endocrine neoplasia 2A (MEN 2A), or Sipple's syndrome is a rare inherited dominant syndrome, characterised by medullary thyroid carcinoma, adrenal pheochromocytoma and hyperparathyroidism, due to specific RET proto-oncogene mutations. The women with MEN 2A syndrome are at risk of complicated pregnancy because of unrecognised pheochromocytoma and transmission of RET mutation to the progeny. We report a case of a woman with MEN 2A diagnosed in early pregnancy. Alpha-blockade medical therapy was used effectively and time was given for fetal maturation. Uncomplicated vaginal delivery performed under epidural analgesia. Six weeks postpartum adrenalectomy, thyroidectomy and parathyroidectomy were performed uneventfully.
Collapse
Affiliation(s)
| | - Nasser Tawfeeq
- Department of Anesthesia, King Abdulaziz Medical City, Riyadh, KSA
| | - Mahmood Nasir
- Department of Anesthesia, King Abdulaziz Medical City, Riyadh, KSA
| | | | - Georges Geldhof
- Department of Anesthesia, King Abdulaziz Medical City, Riyadh, KSA
| | | |
Collapse
|
69
|
|
70
|
Mazza A, Armigliato M, Marzola MC, Schiavon L, Montemurro D, Vescovo G, Zuin M, Chondrogiannis S, Ravenni R, Opocher G, Colletti PM, Rubello D. Anti-hypertensive treatment in pheochromocytoma and paraganglioma: current management and therapeutic features. Endocrine 2014; 45:469-78. [PMID: 23817839 DOI: 10.1007/s12020-013-0007-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/21/2013] [Indexed: 02/06/2023]
Abstract
Pheochromocytoma (PH) and paraganglioma (PG) are neuroendocrine neoplasms arising from chromaffin cells of the adrenal medulla and the sympathetic ganglia, respectively. Although are unusual cause of hypertension (HT) accounting for at most 0.1-0.2 % of cases, they may lead to severe and potentially lethal hypertensive crisis due to the effects of the released catecholamines. However, both PH and PG may be asymptomatic as ~30 % of subjects are normotensive or have orthostatic hypotension and in these cases the 24 h ambulatory blood pressure (BP) monitoring is an important toll to diagnose and treat HT. HT treatment may be difficult when PH or PG occurs in pregnancy or in the elderly subjects and in these cases a multidisciplinary team is required. When surgical excision is mandatory the perioperative management requires the administration of selective α1-adrenergic blocking agents (i.e., doxazosin, prazosin or terazosin) followed by a β-adrenergic blockade (i.e., propranolol, atenolol). This latter should never be started first because blockade of vasodilatory peripheral β-adrenergic receptors with unopposed α-adrenergic receptor stimulation can lead to a further elevation of BP. Although labetalol is traditionally considered the ideal agent due to its α- and β-adrenergic antagonism, experimental studies do not support its use in this clinical setting. As second regimen, the administration of vasodilators as calcium channel blockers (i.e., nicardipine, nifedipine) may be required to control BP. Oral and sublingual short-acting nifedipine are potentially dangerous in patients with hypertensive emergencies and are not recommend. The latest evidences into the diagnosis and treatment of hypertensive crisis due to PH and PG are reviewed here.
Collapse
Affiliation(s)
- Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Dong D, Li H. Diagnosis and treatment of pheochromocytoma during pregnancy. J Matern Fetal Neonatal Med 2014; 27:1930-4. [DOI: 10.3109/14767058.2014.880883] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
72
|
Adrenal mass in pregnancy: Diagnostic approach and dilemmas. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|