CONICET | Buscador de Institutos y Recursos Humanos

Hypertension (HTA) is a common medical complication in pregnancy, with less than 1% to 2% of cases being caused by endocrine disorders. Pheochromocytoma (Pheo) is a rare but important cause of HTA in pregnant patients because of its high morbidity and mortality to both mother and fetus. We report here our experience in 14 patients aged 19-40 years (median 26,5) with Pheo associated with pregnancy. During pregnancy all patients presented the typical features of hypersecretion of catecholamines. Nevertheless, biochemical diagnosis was performed only in 4/14 cases during pregnancy and postpartum in the remaining 10. All patients had HTA (paroxysmal 7/14, sustained 2/14 and sustained with paroxysmal crisis 5/14) associated with a variety of symptoms, the most common being headache (11/14), sweating (10/14) and palpitations (9/14). Measurement of urinary catecholamines showed an increased of either epinephrine (9/14), norepinephrine (13/14) or vanillyl-mandelic acid (13/14). All but one of the patients had adrenal Pheo, two of them bilateral. The remaining one had extra adrenal abdominal Pheo. Three out of the 4 patients whose Pheo was diagnosed during pregnancy had MEN2A, two of them having been diagnosed before pregnancy. All these patients had cesarean deliveries. The tumor was resected at 12 weeks of pregnancy in one, at the time of cesarean in one, at a later date during the postpartum period in one. In the remaining patient surgery was scheduled after cesarean but the patient left the hospital, became pregnant again without any medical care and died during this pregnancy. As for to the patients diagnosed post partum (10/14), one of them had a preterm partum with fetal death, 7 had cesarean delivery and the remaining 2 vaginal delivery. Surprisingly there was no maternal or fetal morbility in either cesarean or vaginal delivery. However, we consider it is essential to think of Pheo in the presence of HTA during pregnancy to ensure full treatment.