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Sghaier A, Reguez T, Moussa A, Ghali AEL, Hamila F, Youssef S. Management of pheochromocytoma during pregnancy. A multidisciplinary challenge: A case reports. Int J Surg Case Rep 2023; 108:108483. [PMID: 37423150 PMCID: PMC10382810 DOI: 10.1016/j.ijscr.2023.108483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Identification of pheochromocytoma during pregnancy is unusual. Lack of appropriate management may be responsible of high risk for both mother and fetus. The guarantee of a successful management of a pheochromocytoma during pregnancy is the establishment of an early diagnosis as well as the prevention of a hypertensive crisis during delivery and surgical treatment and without compromising the maternal-fetal prognosis. CASE PRESENTATION A 31-year-old female patient, without any notable pathological history, pregnant at 20 weeks of amenorrhea was diagnosed for a Menard's triad. The medical investigations had allowed to confirm the diagnosis of left secretory pheochromocytoma. The surgical indication was taken in concertation between surgeons, endocrinologists, gynecologists and anesthesiologists. The parturient had undergone an uneventful laparoscopic left adrenalectomy without incidents. CASE DISCUSSION Our case well illustrates that when the operative indication is posed, laparoscopic surgery can be performed safely during any trimester. However, it is legitimate to modulate the incisions according to gestational age and the height of the fundus. The involvement of all disciplines intervening in the management of the pregnant woman with pheochromocytoma is the guarantor of a favorable maternal-fetal prognosis. CONCLUSION A well-established diagnosis for pregnant women with severe secondary hypertension, multidisciplinary management, and safe laparoscopic approach are crucial to prevent perinatal morbidity and mortality.
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Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
| | - Talel Reguez
- Hospital of Farhat Hached of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Ameni Moussa
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Amine E L Ghali
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Fehmi Hamila
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
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Hamidi OP, Barbour LA. Endocrine Emergencies During Pregnancy: Diabetic Ketoacidosis and Thyroid Storm. Obstet Gynecol Clin North Am 2022; 49:473-489. [PMID: 36122980 DOI: 10.1016/j.ogc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The physiologic changes and common signs and symptoms of pregnancy can make the early recognition of endocrine emergencies more challenging. Diabetic ketoacidosis (DKA) can occur at only modestly elevated glucose levels (euglycemic DKA), often accompanied by starvation ketosis due to substantial fetal-placental glucose demands and is associated with a high stillbirth rate. Thyroid storm is life threatening with a higher rate of heart failure and both require prompt and aggressive treatment to avoid maternal and fetal morbidity and mortality. Treatment of these disorders and the special considerations for recognition and management in the context of pregnancy are reviewed.
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Affiliation(s)
- Odessa P Hamidi
- University of Colorado, School of Medicine, Aurora, CO, USA.
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Abstract
Importance Thyroid disorders represent one of the most frequent complications of pregnancy associated with adverse obstetric, fetal, and neonatal outcomes, especially in case of delayed diagnosis and suboptimal management. Objective The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of these common conditions. Evidence Acquisition A descriptive review of guidelines from the Endocrine Society, the European Thyroid Association, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American Thyroid Association, and the American College of Obstetricians and Gynecologists on thyroid disease in pregnancy was carried out. Results There is an overall consensus regarding the diagnosis of overt and subclinical hypothyroidism and hyperthyroidism in pregnancy using the pregnancy-specific reference ranges and the definition of postpartum thyroiditis. The reviewed guidelines unanimously discourage universal screening for thyroid function abnormalities before and during pregnancy and support targeted screening of high-risk patients by measuring serum thyroid-stimulating hormone levels. Moreover, they all highlight the need of treating overt hypothyroidism and hyperthyroidism, not only during pregnancy, but also before conception, suggesting similar management policies and treatment targets. There is also agreement regarding the management of gestational transient hyperthyroidism with hyperemesis gravidarum, suspected fetal thyrotoxicosis, postpartum thyroiditis, and thyroid malignancy. Scanning or treating with radioactive iodine is contraindicated during pregnancy and breastfeeding. On the other hand, there is controversy on the management of subclinical thyroid disease, thyroid function surveillance protocols, and iodine nutrition recommendations. Of note, the American College of Obstetricians and Gynecologists makes some specific recommendations on the treatment of thyroid storm and thyrotoxic heart failure in pregnant women, whereas the American Thyroid Association makes a special reference to the management of women with thyroid cancer. Conclusions As the disorders of the thyroid gland affect a significant proportion of pregnant women, it is of paramount importance to develop uniform international evidence-based protocols for their accurate diagnosis and optimal management, in order to safely guide clinical practice and eventually improve perinatal outcomes.
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Mabrouk MY, Jabi R, Bouzayan L, Yassin K, Bouziane M. Management of a Left Lateral Aortic Paraganglioma During Pregnancy: A Rare Case Report. Cureus 2021; 13:e19221. [PMID: 34873546 PMCID: PMC8640192 DOI: 10.7759/cureus.19221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/25/2022] Open
Abstract
Paragangliomas are rare neuroendocrine tumors mostly diagnosed in young adults. Their association with pregnancy is even rarer, and their impact is even more serious in the absence of adequate management, which may vitally involve maternal and fetal prognosis. In this report, we present a rare case of a left lateral aortic paraganglioma in a pregnant woman in her third trimester during her 31 weeks of gestation, who consulted for a hypertensive peak; the methoxylated derivatives were positive. An abdominal MRI showed a left lateral aortic mass, suggesting a paraganglioma. After a multidisciplinary discussion, the patient underwent laparoscopic surgical resection of the mass after preoperative medical preparation. Pathological examination confirmed the diagnosis of paraganglioma. The overall stay was six days without any short-term complications, including anything related to fetal viability, with a vaginal delivery at 37 weeks of amenorrhea. The patient was followed up for six months with no complications. We highlight the importance of preoperative medical preparation followed by surgical resection in the framework of a multidisciplinary consultation for an improved maternal-fetal prognosis.
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Affiliation(s)
- Mohamed Yassine Mabrouk
- Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Department of General Surgery, Mohamed VI University Hospital, Oujda, MAR
| | - Rachid Jabi
- Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Department of General Surgery, Mohamed VI University Hospital, Oujda, MAR
| | - Laila Bouzayan
- Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Department of General Surgery, Mohamed VI University Hospital, Oujda, MAR
| | - Kradi Yassin
- Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Department of General Surgery, Mohamed VI University Hospital, oujda, MAR
| | - Mohammed Bouziane
- Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Department of General Surgery, Mohamed VI University Hospital, Oujda, MAR
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Graillon T, Cuny T, Castinetti F, Courbière B, Cousin M, Albarel F, Morange I, Bruder N, Brue T, Dufour H. Surgical indications for pituitary tumors during pregnancy: a literature review. Pituitary 2020; 23:189-199. [PMID: 31691893 DOI: 10.1007/s11102-019-01004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks. METHODS A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy. RESULTS Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing's disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit. CONCLUSION Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix-Marseille Univ, INSERM, MMG, Marseille, France.
| | - Thomas Cuny
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Frédéric Castinetti
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Blandine Courbière
- Centre Clinico-Biologique d'AMP, Pôle Femmes-Parents-Enfants, Hôpital de La Conception, AP-HM, Marseille/Aix Marseille Univ, Avignon Univ, CNRS, IRD, IBME, Marseille, France
| | - Marie Cousin
- Cabinet d'Ophtalmologie, Saint-Rémy de Provence, France
| | - Frédérique Albarel
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Isabelle Morange
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Nicolas Bruder
- Anesthesiology-Intensive Care Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
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Abstract
Hypertension is a common and morbid complication of pregnancy. While endocrine causes of secondary hypertension are not rare, women with these conditions do not often conceive, and even less commonly are these disorders diagnosed during pregnancy. This review will consider conditions of adrenal hormone excess that cause secondary hypertension: primary aldosteronism (PA), Cushing syndrome (CS), and pheochromocytoma/paraganglioma. We emphasize that pregnancy itself elicits changes in the regulation of aldosterone and cortisol production and standard endocrine testing algorithms. Furthermore, conventional imaging modalities and pharmacotherapies are often contraindicated in pregnancy, which complicates diagnosis and management. Nevertheless, surgical management in the second trimester is the preferred treatment strategy for most of these rare cases when feasible. This article will discuss the approach to patients with endocrine causes of hypertension during pregnancy with emphasis on those aspects that deviate from the assessment and treatment of non-pregnant patients.
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Affiliation(s)
- Alison H Affinati
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
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Chanson P, Vialon M, Caron P. An update on clinical care for pregnant women with acromegaly. Expert Rev Endocrinol Metab 2019; 14:85-96. [PMID: 30696300 DOI: 10.1080/17446651.2019.1571909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION As pregnancy is rare in women with acromegaly, only case reports and few series have been published. AREAS COVERED All case reports and publications dealing with pregnancy in patients with acromegaly were collated. Information concerning the effects of acromegaly on pregnancy outcomes, the impact of pregnancy on GH/IGF-I measurements, acromegaly comorbidity and pituitary adenoma size, the effects of treatment of acromegaly on fetus outcomes were retrieved and analyzed. EXPERT COMMENTARY Based on the small number of reported cases, pregnancy is generally uneventful, except for a potential increased incidence of gestational hypertension and diabetes mellitus. Medical therapy of acromegaly (dopamine agonists, somatostatin analogs, growth hormone-receptor antagonists) is generally interrupted before or at diagnosis of pregnancy. In very rare patients with a pituitary adenoma, particularly a macroadenoma that has not been surgically treated before pregnancy, or if a surgical remnant persists, or when acromegaly is revealed during pregnancy, tumor volume may increase and cause symptoms through a mass effect. Close monitoring of clinical manifestations and imaging are necessary during pregnancy in these cases. In the rare cases of symptomatic tumor enlargement during pregnancy, medical treatment with dopamine agonists or eventually somatostatin analogs may be attempted before resorting to transsphenoidal surgery.
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Affiliation(s)
- Philippe Chanson
- a Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Mladies Rares de l'Hypophyse , Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
- b Unité Mixte de Recherche S1185 Facultéde Médecine Paris-Sud , University Paris-Sud , Le Kremlin Bicêtre , France
- c Unit 1185, Institut National de la Santé et de laRecherche Médicale (INSERM) , Le Kremlin Bicêtre , France
| | - Magaly Vialon
- d Service d'Endocrinologie et des Maladies Métaboliques , Centre Hospitalier Universitaire de Toulouse, Hôpital Larrey , Toulouse , France
| | - Philippe Caron
- d Service d'Endocrinologie et des Maladies Métaboliques , Centre Hospitalier Universitaire de Toulouse, Hôpital Larrey , Toulouse , France
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9
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Caimari F, Valassi E, Garbayo P, Steffensen C, Santos A, Corcoy R, Webb SM. Cushing's syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine 2017; 55:555-563. [PMID: 27704478 DOI: 10.1007/s12020-016-1117-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
Pregnancy in Cushing's syndrome (CS) is extremely rare due to the influence of hypercortisolism on the reproductive axis. Purpose of this study is to investigate whether the etiology of CS in pregnancy determines a different impact on the fetal/newborn and maternal outcomes. We performed a systematic review of cases published in the literature from January 1952 to April 2015 including the words "Cushing AND pregnancy". We included 168 manuscripts containing 220 patients and 263 pregnancies with active CS during pregnancy and with a history of CS but treated and cured hypercortisolism at the time of gestation. Adrenal adenoma was the main cause of active CS during pregnancy (44.1 %). Women with active CS had more gestational diabetes mellitus (36.9 vs. 2.3 %, p = 0.003), gestational hypertension (40.5 vs. 2.3 %, p < 0.001) and preeclampsia (26.3 vs. 2.3 %, p = 0.001) than those with cured disease. The proportion of fetal loss in active CS was higher than in cured CS (23.6 vs. 8.5 %, p = 0.021), as well as global fetal morbidity (33.3 vs. 4.9 %, p < 0.001). The predictors of fetal loss in active CS were etiology of hypercortisolism [Odds Ratio -OR-for pregnancy-induced CS 4.7 (95 % Confidence Interval-CI 1.16-18.96), p = 0.03], publication period [OR for "1975-1994" 0.10 (95 % CI 0.03-0.40), p = 0.001] and treatment during gestation (p = 0.037, [OR medical treatment 0.25 (95 % CI 0.06-1.02), p = 0.052], [OR surgical treatment 0.34 (95 % CI 0.11-1.06), p = 0.063]). The period of diagnosis of CS (before, during or after pregnancy) was the only predictor of overall fetal morbimortality [OR for diagnosis during pregnancy 4.66 (95 % CI 1.37-15.83), p = 0.014]. Patients with active CS, especially in pregnancy-induced CS, experienced more problems in pregnancy and had the worst fetal prognosis in comparison to other causes. Diagnosis of CS during pregnancy was also associated with worse overall fetal morbimortality. Both medical treatment and surgery during pregnancy appeared to be protective in avoiding fetal loss.
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Affiliation(s)
- Francisca Caimari
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - Alicia Santos
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rosa Corcoy
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain.
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Abbassy M, Kshettry VR, Hamrahian AH, Johnston PC, Dobri GA, Avitsian R, Woodard TD, Recinos PF. Surgical management of recurrent Cushing's disease in pregnancy: A case report. Surg Neurol Int 2015; 6:S640-5. [PMID: 26682090 PMCID: PMC4672578 DOI: 10.4103/2152-7806.170472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Cushing's disease is a condition rarely encountered during pregnancy. It is known that hypercortisolism is associated with increased maternal and fetal morbidity and mortality. When hypercortisolism from Cushing's disease does occur in pregnancy, the impact of achieving biochemical remission on fetal outcomes is unknown. We sought to clarify the impact of successful surgical treatment by presenting such a case report. Case Description: A 38-year-old pregnant woman with recurrent Cushing's disease after 8 years of remission. The patient had endoscopic transsphenoidal of her pituitary adenoma in her 18th week of pregnancy. The patient had postoperative biochemical remission and normal fetal outcome with no maternal complications. Conclusion: Transsphenoidal surgery for Cushing's disease can be performed safely during the second trimester of pregnancy.
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Affiliation(s)
- Mahmoud Abbassy
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Minimally Invasive Cranial Base and Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Minimally Invasive Cranial Base and Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amir H Hamrahian
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA
| | - Philip C Johnston
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA
| | - Georgianna A Dobri
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rafi Avitsian
- Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Troy D Woodard
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Minimally Invasive Cranial Base and Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio, USA ; Section of Skull Base Rhinology and Sinus Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Minimally Invasive Cranial Base and Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio, USA ; Section of Skull Base Rhinology and Sinus Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Thyroid diseases in pregnancy: a current and controversial topic on diagnosis and treatment over the past 20 years. Arch Gynecol Obstet 2015; 292:995-1002. [DOI: 10.1007/s00404-015-3741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
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Ganguly S, LeBeau S, Pierce K, Ramanathan R, Salata R. Multiple Paragangliomas in a Pregnant Patient with a Succinate Dehydrogenase B Mutation. Postgrad Med 2015; 122:46-50. [DOI: 10.3810/pgm.2010.11.2222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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George MM, Goswamy J, Penney SE. Embolic suppurative thyroiditis with concurrent carcinoma in pregnancy: lessons in management through a case report. Thyroid Res 2015; 8:3. [PMID: 25741383 PMCID: PMC4349691 DOI: 10.1186/s13044-015-0015-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The thyroid undergoes a variety of physiological changes during pregnancy. The relatively low iodine levels seen in pregnancy have been implicated in thyroid growth during this time. Management of thyroid cancer in pregnancy is not immediately apparent. Furthermore, acute suppurative thyroiditis is rare and this is attributed to the glands innate immunity. We thoroughly review the evidence regarding management of thyroid abscess and thyroid malignancy during pregnancy and illustrate it via an extremely rare case of an embolic thyroid abscess highlighting an underlying carcinoma in a pregnant woman. CASE A 29-year old female was found to have a thyroid mass during an antenatal assessment. Following a wound infection from Caesarian section she developed a rapidly progressive thyroid abscess. Incision and drainage of the abscess, and subsequent histology revealed papillary carcinoma. She subsequently underwent both total thyroidectomy with level 6 dissection and radio-iodine ablation post-natally. CONCLUSION The literature is inconsistent regarding pregnancy as a risk factor for thyroid cancer, but overall it has been suggested as equally or slightly more frequent than in the non-pregnant population. Thyroid mass investigation should be as for the non-pregnant population. In the first trimester any endocrine surgery is associated with miscarriage, whereas these risks are reduced in second trimester. Importantly, there is no survival benefit in undergoing papillary carcinoma surgery in the third trimester versus early post partum and the risks of premature labour may outweigh any benefit gained by operating early. Most importantly, acute suppurative thyroiditis is rare entity and clinicians should have a low threshold for suspicion of underlying malignancy in these patients. This is especially true in the pregnant population who may be especially susceptible whilst undergoing hypertrophic thyroid changes.
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Affiliation(s)
- Manish M George
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
| | - Jay Goswamy
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
| | - Susannah E Penney
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
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Cabezón CA, Carrizo LC, Costanzo PR. Evolution of differentiated thyroid cancer during pregnancy in a community University Hospital in Buenos Aires, Argentina. ACTA ACUST UNITED AC 2014; 57:307-11. [PMID: 23828435 DOI: 10.1590/s0004-27302013000400005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the presentation, follow-up and evolution of differentiated thyroid cancer (DTC) detected during pregnancy. SUBJECTS AND METHODS Twenty nine women with DTC detected during pregnancy were analyzed. Group I (n = 13) was seen during pregnancy and DTC was diagnosed during gestation; detection of the nodule occurred during pregnancy (first trimester). Group II (n = 16) was seen after delivery; detection of the nodule occurred during pregnancy (second or third trimester). Complete thyroidectomy, ablative dose of radioactive iodine, and treatment with levothyroxine were performed. FOLLOW-UP neck ultrasound; TSH, free T4, thyroglobulin, and anti-thyroglobulin antibodies with and without treatment with levothyroxine; and 131I whole body scans. Histological diagnosis, lymph node metastases, tumor size and stage, complications from pregnancy, and DTC evolution were evaluated. RESULTS 100% of the patients had papillary thyroid carcinoma. Lymph node metastases were detected in 13 (44.8%), and invasion of adjacent extrathyroid tissue in 2 patients. Tumor size was larger in Group II: 22.1 ± 10.9 versus 13.9 ± 3.5 mm; p = 0.03. No differences were found in the tumor stages between groups. All patients had full-term pregnancies and healthy newborns. FOLLOW-UP 5.7 ± 4.3 years; one patient had persistent disease. CONCLUSIONS DTC detected during pregnancy had a favorable evolution. Surgery may be postponed to the post-delivery period, unless there are risk factors that justify it during pregnancy.
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Affiliation(s)
- Carmen Amalia Cabezón
- Endocrinology, Metabolism and Nuclear Medicine Service, Hospital Italiano de Buenos Aires, Argentina
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Berrío Valencia MI, Vallejo Yepes C. Functional adrenal adenoma in a pregnant woman with a 32 week gestation scheduled for cesarean section. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rcae.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2543-65. [PMID: 22869843 DOI: 10.1210/jc.2011-2803] [Citation(s) in RCA: 728] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). EVIDENCE This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. CONSENSUS PROCESS The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. CONCLUSIONS Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.
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Affiliation(s)
- Leslie De Groot
- University of Rhode Island, Providence, Rhode Island 02881, USA
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17
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Adenoma suprarrenal funcional en gestante de 32 semanas programada para cesárea. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rca.2012.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Abstract
Pregnancy causes a number of physiological alterations in thyroid hormone metabolism that need to be distinguished from the pathophysiological states of thyroid dysfunction. Both hypothyroidism and thyrotoxicosis may impair the course of pregnancy and may negatively affect the fetus. In particular, maternal hypothyroidism may lead to irreparable and detrimental deficits in the neurocognitive development of the fetus. Autoimmune thyroid disease is the most common cause of thyroid dysfunction in pregnancy. Hashimoto's thyroiditis is associated with impaired fertility and miscarriage, and may first manifest in pregnancy due to the increased thyroid hormone requirement. Graves' disease often shows a characteristic course in pregnancy with amelioration of thyrotoxicosis in the second half of pregnancy and exacerbation after delivery. In addition transplacental passage of maternal TSH receptor antibodies may lead to thyrotoxicosis in the fetus and/or newborn.
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Functional adrenal adenoma in a pregnant woman with a 32 week gestation scheduled for cesarean section☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240030-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Abstract
Endocrine tumours occur rarely in pregnant women but present clinicians with unique challenges. A high index of suspicion is often required to make a diagnosis since the symptoms and signs associated with many of these tumours, including insulinoma, adrenocortical carcinoma and phaeochromocytoma, mimic those of normal pregnancy or its complications, such as pre-eclampsia. The evidence base which informs management is very limited hence decisions on investigation and therapy must be individualised and undertaken jointly by the multidisciplinary medical team and the patient. The optimal strategy will depend on the nature and stage of the endocrine tumour, gestational stage, treatments available and patient wishes. Thus, surgical intervention, appropriately timed, may be considered in pregnancy for resectable adrenocortical carcinoma or phaeochromocytoma, but delayed until the postpartum period for well-differentiated thyroid cancer. Medical therapy may be required to reduce the drive to tumour growth, control symptoms of hormone excess and to minimise the risks of surgery, anaesthesia or labour.
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Affiliation(s)
- A Lansdown
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, UK.
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21
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Acromegaly and pregnancy. ANNALES D'ENDOCRINOLOGIE 2011; 72:282-286. [DOI: 10.1016/j.ando.2011.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 11/22/2022]
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22
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Mayr J, Kohlfürst S, Gallowitsch HJ, Lind P, Mikosch P. [Thyroid and pregnancy]. Wien Med Wochenschr 2010; 160:186-93. [PMID: 20473730 DOI: 10.1007/s10354-010-0760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
Screening for thyroid dysfunction is recommended among certain groups of women, who plan a pregnancy, for example women with history of hyperthyroid or hypothyroid disease, with type 1 diabetes or other autoimmune disorders or women with previous therapeutic head or neck irradiation, in the case of infertility. Management of thyroid disease during pregnancy requires special consideration because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse affects on the pregnancy and the foetus. Under ideal conditions there is a cooperation among several healthcare professionals, such as endocrinologists, nuclear medicine physicians, gynaecologists, neonatologists and if necessary surgeons. This article surveys the physiological and pathological changes of thyroid, their diagnosis and therapy in the case of women in childbearing age, women with unfulfilled desire to have children, pregnant women, as well as women after delivery.
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Affiliation(s)
- Johanna Mayr
- Abteilung für Nuklearmedizin und spezielle Endokrinologie PET/CT-Zentrum, Landeskrankenhaus Klagenfurt, Klagenfurt, Osterreich.
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23
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Karger S, Führer-Sakel D. [Thyroid diseases and pregnancy]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2009; 104:450-6. [PMID: 19533052 DOI: 10.1007/s00063-009-1094-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 03/31/2009] [Indexed: 11/28/2022]
Abstract
Thyroid diseases in pregnancy must be recognized as a specific challenge for the clinician. Any pregnancy is causing alterations in thyroid hormone metabolism which have to be differentiated from pathologic states of thyroid function. Any thyroid disease of the mother with disturbances in the functional state of the gland could induce an adverse influence on the course of pregnancy. Furthermore, it can be associated with adverse consequences on fetal development. Especially hypothyroidism has to be avoided during pregnancy due to a danger of affected neurocognitive development of the offspring. Yet also maternal hyperthyroidism can lead to impairments in the course of pregnancy and to fetal thyroid dysfunction. Further clinical attention should be given to thyroid autoimmunity. There is a clear relationship between autoimmune thyroid disease and decreased fertility and an increase in the rate of spontaneous miscarriages. Furthermore, it displays an increased risk for the manifestation of postpartum thyroiditis. The management of nodular thyroid disease and malignancy does not differ from that of nonpregnant women/patients. Thyroid scintiscan and radioiodine therapy must be avoided during pregnancy and lactation. This review deals with the broad variety of thyroid disorders and function disturbances during and after pregnancy. All described diagnostic and therapeutic procedures are based upon the recent Clinical Practice Guideline of the Endocrine Society published in August 2007.
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Affiliation(s)
- Stefan Karger
- Klinik für Endokrinologie, Diabetologie und Nephrologie, Department Innere Medizin, Universitätsklinikum Leipzig
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Asensio Martín MJ, Pavón Benito A, Barrena Sotes J, Zabaleta Zúñiga A, Salvador Bravo M. [Anesthesia for surgical removal of a pheochromocytoma during the first trimester of pregnancy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:129-131. [PMID: 19334670 DOI: 10.1016/s0034-9356(09)70352-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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25
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Frayssinet C, Vezzosi D, Huyghe E, Lorenzini F, Bennet A, Caron P. Surrénalectomie par cœlioscopie rétropéritonéale au cours de la grossesse chez une patiente présentant un phéochromocytome dans le cadre d’une NEM2a : un nouveau cas et revue de la littérature. ANNALES D'ENDOCRINOLOGIE 2008; 69:53-7. [DOI: 10.1016/j.ando.2007.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. Thyroid 2007; 17:1159-67. [PMID: 18047433 DOI: 10.1089/thy.2007.1523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92:S1-47. [PMID: 17948378 DOI: 10.1210/jc.2007-0141] [Citation(s) in RCA: 464] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective is to provide clinical guidelines for the management of thyroid problems present during pregnancy and in the postpartum. PARTICIPANTS The Chair was selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society. The Chair requested participation by the Latin American Thyroid Society, the Asia and Oceania Thyroid Society, the American Thyroid Association, the European Thyroid Association, and the American Association of Clinical Endocrinologists, and each organization appointed a member to the task force. Two members of The Endocrine Society were also asked to participate. The group worked on the guidelines for 2 yr and held two meetings. There was no corporate funding, and no members received remuneration. EVIDENCE Applicable published and peer-reviewed literature of the last two decades was reviewed, with a concentration on original investigations. The grading of evidence was done using the United States Preventive Services Task Force system and, where possible, the GRADE system. CONSENSUS PROCESS Consensus was achieved through conference calls, two group meetings, and exchange of many drafts by E-mail. The manuscript was reviewed concurrently by the Society's CGS, Clinical Affairs Committee, members of The Endocrine Society, and members of each of the collaborating societies. Many valuable suggestions were received and incorporated into the final document. Each of the societies endorsed the guidelines. CONCLUSIONS Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on the pregnancy and the fetus. Care requires coordination among several healthcare professionals. Avoiding maternal (and fetal) hypothyroidism is of major importance because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Maternal hyperthyroidism and its treatment may be accompanied by coincident problems in fetal thyroid function. Autoimmune thyroid disease is associated with both increased rates of miscarriage, for which the appropriate medical response is uncertain at this time, and postpartum thyroiditis. Fine-needle aspiration cytology should be performed for dominant thyroid nodules discovered in pregnancy. Radioactive isotopes must be avoided during pregnancy and lactation. Universal screening of pregnant women for thyroid disease is not yet supported by adequate studies, but case finding targeted to specific groups of patients who are at increased risk is strongly supported.
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Affiliation(s)
- Marcos Abalovich
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
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28
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Oger P, Raiffort C, Plouin PF, Mandelbrot L. Phéochromocytome et grossesse. À propos d'un cas. ACTA ACUST UNITED AC 2006; 34:323-5. [PMID: 16564734 DOI: 10.1016/j.gyobfe.2005.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 12/02/2005] [Indexed: 11/16/2022]
Abstract
The management of a pheochromocytoma during pregnancy is uncommon and is at high risk for both mother and foetus. We report a case of a patient whose first pregnancy was complicated by foetal demise in a context suggestive of preeclampsia. She was diagnosed with pheochromocytoma as she was beginning a second pregnancy. A laparoscopic adrenalectomy was performed in the first trimester of pregnancy, and maternal and neonatal outcome were favourable. This case illustrates the difficulty of diagnosing pheochromocytoma in pregnancy, and the benefits of laparoscopic treatment in the first trimester.
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Affiliation(s)
- P Oger
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
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Miyoshi T, Otsuka F, Suzuki J, Inagaki K, Takeda M, Kano Y, Yamashita T, Ogura T, Date I, Tanaka Y, Hashimoto K, Makino H. Periodic secretion of adrenocorticotropin in a patient with Cushing's disease manifested during pregnancy. Endocr J 2005; 52:287-92. [PMID: 16006722 DOI: 10.1507/endocrj.52.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report the case of 19-year-old woman with cyclical Cushing's disease, in whom plasma adrenocorticotropin (ACTH) was secreted periodically after her first pregnancy. Since the 33rd week of pregnancy, hypertension and proteinuria became clinically remarkable. She gave normal birth at 36th week of pregnancy; however she continued to gain body weight even after delivery and developed typical Cushingoid features. Her ACTH secretion lacked normal daily fluctuation but exhibited periodic change during 1-year observation, showing 119 pg/ml, 34.6 pg/ml and 115 pg/ml at the 4th, 7th and 13th months after delivery. Plasma ACTH levels were increased by corticotropin releasing hormone and metyrapone, while low-dose dexamethasone suppressed cortisol secretion. Gel filtration analysis of the patient's plasma detected big ACTH molecules being eluted with a peak of authentic 1-39 ACTH. Cranial magnetic resonance imaging revealed a 1-cm pituitary mass in right cavernous sinus. The pituitary tumor was removed by transsphenoidal surgery at 13th month after delivery and was pathologically compatible with ACTH-producing pituitary adenoma by immunohistochemistry. This case includes clinically rare subsets of Cushing's syndrome showing periodic ACTH secretion and aberrant ACTH molecules.
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Affiliation(s)
- Tomoko Miyoshi
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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30
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Miller C, Bernet V, Elkas JC, Dainty L, Gherman RB. Conservative Management of Extra-Adrenal Pheochromocytoma During Pregnancy. Obstet Gynecol 2005; 105:1185-8. [PMID: 15863575 DOI: 10.1097/01.aog.0000141555.91842.c2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extra-adrenal pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the paraganglion sympathetic system. All of the previously reported cases have described surgical resection during the antepartum period. CASE At 14 weeks of gestation, a multiparous patient was diagnosed with an extra-adrenal dopaminergic pheochromocytoma. A decision was made to delay surgical intervention until the postpartum period. Phenoxybenzamine, 10 mg per day, was subsequently started. At 35 + 2 weeks of gestation, the patient delivered a 2,600 g infant via an uncomplicated cesarean. Three weeks later, the extra-adrenal pheochromocytoma was removed, and she also underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and rectosigmoid resection with end-to-end colostomy. CONCLUSION Conservative management of dopaminergic-secreting extra-adrenal pheochromocytomas can result in favorable maternal and fetal outcomes.
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Affiliation(s)
- Caela Miller
- Department of Obstetrics and Gynecology, Division of Maternal/Fetal Medicine, National Naval Medical Center, Bethesda, Maryland 20889, USA
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31
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Abstract
Stroke in pregnancy and the puerperium is a rare but serious cause of maternal and fetal mortality. Pregnancy-associated maternal changes should remain additional considerations in the evaluation and treatment of the pregnant patient who has stroke and not preclude a comprehensive stroke evaluation. Instead, the approach to the pregnant patient who has stroke should include the evaluation of general causes of stroke in the young, with the additional consideration of the rare pregnancy-specific causes. Understanding the potential maternal and fetal risks of diagnostic testing and treatment is crucial to appropriate decision making when caring for the pregnant patient who has stroke.
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Affiliation(s)
- Tanya N Turan
- Department of Neurology, Emory University School of Medicine, Department of Neurology, 639 Pierce Drive, Atlanta, GA 30322, USA
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