Abstract 52: Pheochromocytoma in pregnancy: Our experience

Introduction: Pheochromocytoma in pregnancy is extremely rare. Early diagnosisand management can significantly alter maternal and fetaloutcome. However timely diagnosis can be challenging due to several close differential diagnosis. most common cause of hypertension Case-1: 24 yr female, presented to us at 24 wk of gestation for evaluation of hypertension. She complained of headache and excessive sweating. She was diagnosed to behypertensive in previous pregnancy, at 3months of gestation. Highest recorded BP-200/100mm Hg and IUD occurred at 9 months gestation. Onevaluation we found Urinary metanephrine-291 ug/24 hr, normetanephrine-9450 ug/24 hr (<600 mcg/24 hr). MRI abdomen showed-T2 hyperintense mass 3.4 x 2.2 cm in right adrenal and 6 x 5.7 cm mass in left adrenal. After optimisation of blood pressure and alpha blockade LSCS was done at 34 wk gestation. Post -LSCS, baby recovered with CPAP support after 2 days. Laproscopic right cortical preserving adrenalectomy and left total adrenalectomy was done after 8 wks postpartum. After 2 months of follow up, patientis now off anti-hypertensive. Case-2: 28 yr female at 13 week of gestation presented for evaluation of HTN and left adrenalmass. She was Diagnosed hypertensive 8 yr back on regular medication. Usg showed-4 x 3.5 cm left suprarenal mass. Urinary metanephrine-139 ug/24 hr, normetanephrine-2361 ug/24 hr. MRI abdomen – 4 x 4.2 x 3.7 cm solid cystic lesion anterior superior upper pole of left kidney –pheochromocytoma. After adequate alpha blockade, left adrenalectomy was done at 19th wk gestation. Patient is now off antihypertensive 25th wk gestation. Conclusion: During pregnancy, pre-treatment with alpha blockade is challenging due to risk of compromised uteroplacental circulation, laparoscopic surgery is the preferred approach for resection of the pheochromocytoma in pregnancy. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester. The preferred route and timing of delivery, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team.