Pheochromocytoma in pregnancy – a case report and review of the literature

Pheochromocytoma is a rare disease that may occur during pregnancy.Several hundred cases have been published.When pheochromocytoma complicates pregnancy, early diagnosis and treatment is essential because of the high risks for mother and fetus.Differentiation from other clinical conditions, especially toxemia, is difficult but important.Diagnosis is made by measurement of catecholamines or their metabolites in urine, or in plasma.Tumor localization is established generally by computed tomography (CT) or magnetic resonance imaging (MRI).Pheochromocytoma is treated medically by a-adrenergic blockers, followed by b-blockers, followed by surgery, which is the definitive treatment.We describe a patient who, at 25 weeks' gestation, was diagnosed as suffering from pheochromocytoma. Case reportA 26-year-old woman was referred to our outpatient clinic because of chronic hypertension in the 12th week of her third pregnancy.Until one year previously, she had been healthy.In 1995 she had a normal pregnancy and delivery.In 1997, during the 23rd week of her second pregnancy, the woman was admitted to the Intensive Care Unit because of pulmonary edema and respiratory failure, but no hypertension.A presumptive diagnosis of viral myocarditis was made, despite no virus being isolated.During her stay in hospital, the fetus died and she delivered a stillborn neonate.Subsequently, the woman was admitted twice to the Internal Medicine Department due to a hypertensive crisis (BP 200/110), flushing and tremor, but no specific diagnosis was made.On both occasions, she was discharged without treatment.An ambulatory CT done at that time was interpreted as normal.During the woman's first visit to our Outpatient Clinic, her