Late diagnosis of pheochromocytoma in pregnancy with poor fetal outcome

Gauri Bapayeva; Milan Terzic; Karlygash Togyzbayeva; Aigerim Bekenova; Sanja Terzic; Simone Garzon; Giovanni Falzone; Botagoz Aitbayeva

doi:10.2298/AOO191012002B

Gauri Bapayeva Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan. Department of Medicine, Nazarbayev University, School of Medicine, Astana, Kazakhstan.
Milan Terzic Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan. Department of Medicine, Nazarbayev University, School of Medicine, Astana, Kazakhstan. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
Karlygash Togyzbayeva Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
Aigerim Bekenova Department of Medicine, Nazarbayev University, School of Medicine, Astana, Kazakhstan.
Sanja Terzic Department of Medicine, Nazarbayev University, School of Medicine, Astana, Kazakhstan
Simone Garzon Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
Giovanni Falzone Obstetrics and Gynaecology Unit, “Umberto I” Hospital, Enna, Italy
Botagoz Aitbayeva Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan

DOI: https://doi.org/10.2298/AOO191012002B

Keywords: Pheochromocytoma, Pregnancy, Hypertension, intrauterine growth restriction, Maternal-fetal outcome

Abstract

Pheochromocytomas are rare tumors producing catecholamines that could be a cause of secondary hypertension. On that basis, pheochromocytoma can occur as an extremely rare cause of hypertension in pregnancy and if diagnosed late can lead to adverse maternal-fetal outcome. In this case report we describe a case of pheochromocytoma affected pregnancy with poor fetal outcome. A 27-year-old pregnant woman was admitted for severe pre-eclampsia due to pre-gestational hypertension that was diagnosed during the first trimester. Due to high and uncontrolled maternal blood pressure and the worsened maternal-fetal condition after the admission induction of fetal lung maturity and emergency cesarean section were performed, but with poor fetal outcome. Later, an adrenal gland mass was identified using abdominal ultrasound and confirmed by computed tomography. After surgical adrenalectomy blood pressure of the patient was normalized. Pheochromocytoma should be considered as a possible cause of hypertensive disorder during pregnancy, particularly in cases of severe and unresponsive hypertension in order to provide for timely and appropriate treatment.

References

Prosperi Porta R, Lalle M, Calzolari E, Polistina M, Patella A. Fatal Phaechromocytoma in Pregnancy. Case Report. Ital J Gynaecol Obstet 1996;4:162–4.

Periti E, Cordisco A, Lozza V, Conticini S, Spitaleri M, Farruggia A. The impact of the combined test on the first trimester as a method of screening for trisomies 21,18, 13 and other chromosomal abnormalities. Experience of a single Italian fetal medicine unit on 12618 consecutives pregnancies. Ital J Gynaecol Obstet 2017;29:23–9.

Vitale SG, Padula F, Gulino FA. Management of uterine fibroids in pregnancy: recent trends. Curr Opin Obstet Gynecol 2015;27:432–7. doi:10.1097/GCO.0000000000000220.

Cacciottola L, Solima E, Trojano G, Montesano M, Busacca M, Vignali M. Management of adnexal masses during the third trimester of pregnancy: a case report in twin-pregnancy and review of the literature. Ital J Gynaecol Obstet 2016;28:36–40.

Chiofalo B, Laganà AS, Vaiarelli A, La Rosa VL, Rossetti D, Palmara V, et al. Do miRNAs Play a Role in Fetal Growth Restriction? A Fresh Look to a Busy Corner. Biomed Res Int 2017;2017:6073167. doi:10.1155/2017/6073167.

Laganà AS, Vitale SG, Sapia F, Valenti G, Corrado F, Padula F, et al. miRNA expression for early diagnosis of preeclampsia onset: hope or hype? J Matern Neonatal Med 2018;31:817–21. doi:10.1080/14767058.2017.1296426.

Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertens (Dallas, Tex 1979) 2009;53:944–51. doi:10.1161/HYPERTENSIONAHA.109.130765.

Laganà AS, Giordano D, Loddo S, Zoccali G, Vitale SG, Santamaria A, et al. Decreased Endothelial Progenitor Cells (EPCs) and increased Natural Killer (NK) cells in peripheral blood as possible early markers of preeclampsia: a case-control analysis. Arch Gynecol Obstet 2017;295:867–72. doi:10.1007/s00404-017-4296-x.

Salman H, Shah M, Ali A, Aziz A, Vitale SG. Assessment of Relationship of Serum Neurokinin-B Level in the Pathophysiology of Pre-eclampsia: A Case–Control Study. Adv Ther 2018;35:1114–21. doi:10.1007/s12325-018-0723-z.

Biggar MA, Lennard TWJ. Systematic review of phaeochromocytoma in pregnancy. Br J Surg 2013;100:182–90. doi:10.1002/bjs.8976.

Giampaolino P, Della Corte L, Formisano C, Cuomo L, Maurea S, Romeo V, et al. Successful management of a third-trimester pregnancy complicated by pheochromocytoma: case report. Gynecol Endocrinol 2018;34:1016–8. doi:10.1080/09513590.2018.1480712.

Wing LA, Conaglen J V, Meyer-Rochow GY, Elston MS. Paraganglioma in Pregnancy: A Case Series and Review of the Literature. J Clin Endocrinol Metab 2015;100:3202–9. doi:10.1210/jc.2015-2122.

Lenders JWM, Duh Q-Y, Eisenhofer G, Gimenez-Roqueplo A-P, Grebe SKG, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99:1915–42. doi:10.1210/jc.2014-1498.

Sarathi V, Lila AR, Bandgar TR, Menon PS, Shah NS. Pheochromocytoma and pregnancy: a rare but dangerous combination. Endocr Pract 2010;16:300–9. doi:10.4158/EP09191.RA.

Ghalandarpoor-Attar SN, Ghalandarpoor-Attar SM, Borna S, Ghotbizadeh F. A rare presentation of pheochromocytoma in pregnancy: a case report. J Med Case Rep 2018;12:37. doi:10.1186/s13256-017-1549-z.

Langton K, Gruber M, Masjkur J, Steenblock C, Peitzsch M, Meinel J, et al. Hypertensive crisis in pregnancy due to a metamorphosing pheochromocytoma with postdelivery Cushing’s syndrome. Gynecol Endocrinol 2018;34:20–4. doi:10.1080/09513590.2017.1379497.

van der Weerd K, van Noord C, Loeve M, Knapen MFCM, Visser W, de Herder WW, et al. ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature. Eur J Endocrinol 2017;177:R49–58. doi:10.1530/EJE-16-0920.

Vitale SG, Laganà AS, Muscatello MRA, La Rosa VL, Currò V, Pandolfo G, et al. Psychopharmacotherapy in Pregnancy and Breastfeeding. Obstet Gynecol Surv 2016;71:721–33. doi:10.1097/OGX.0000000000000369.

Breathnach FM, Malone FD, Lambert-Messerlian G, Cuckle HS, Porter TF, Nyberg DA, et al. First- and Second-Trimester Screening: detection of aneuploidies other than Down syndrome. Obstet Gynecol 2007;110:651–7. doi:10.1097/01.AOG.0000278570.76392.a6.

Abuhamad A. Three-dimensional ultrasound with color Doppler imaging of an umbilical cord true knot. Ultrasound Obstet Gynecol 2014;43:360–360. doi:10.1002/uog.13297.

Björklund P, Backman S. Epigenetics of pheochromocytoma and paraganglioma. Mol Cell Endocrinol 2018;469:92–7. doi:10.1016/j.mce.2017.06.016.

Kim HJ, Yang SH, Yang SH, Han SS, Kim GJ. Extra-adrenal paraganglioma masquerading as severe preeclampsia. Obstet Gynecol Sci 2018;61:520–3. doi:10.5468/ogs.2018.61.4.520.