| Am J Hypertens. 2005 Oct;18(10):1306-12 |
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| Peripartum hypertension from pheochromocytoma: a rare and challenging
entity |
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| Kamari Y, Sharabi Y, Leiba A, Peleg E, Apter S, Grossman E. |
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| Department of Internal Medicine D and Hypertension Unit, The Chaim
Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School
of Medicine, Tel-Aviv University, Israel |
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| BACKGROUND: Pheochromocytoma, a rare and usually curable cause of
hypertension, is characterized by symptoms and signs related to increased
catecholamine secretion. Pregnancy can elicit clinical manifestations
of otherwise unrecognized pheochromocytoma. METHODS AND RESULTS: Four
women, ranging in age from 27 to 37 years, were referred to the hypertension
clinic with the following presentations: 1) a 35-year-old woman, diagnosed
with gestational hypertension and headaches during the third trimester
of her pregnancy and 5 months after delivery, was hospitalized with
pulmonary edema. Echocardiography revealed severe dilated left ventricular
(LV) dysfunction. Cardiac function was normalized after surgical resection
of a pheochromocytoma from her left adrenal; 2) a 37-year-old woman
suffered from preeclampsia, persistent hypertension and orthostatic
hypotension after a cesarean section. A diagnostic work-up revealed
a catecholamine-secreting paraganglioma in the retroperitoneum. The
patient underwent a laparosopic resection of the tumor; 3) a 27-year-old
woman suffered from hypertension and episodes of palpitations, sweating,
and dyspnea in the first trimester of her pregnancy. An ultrasound
revealed a 5-cm mass in the left adrenal. She underwent a left adrenalectomy
at the 17th week of pregnancy, which confirmed the diagnosis of pheochromocytoma;
4) a 34-year-old woman, at the 26th week of pregnancy, presented with
an acute loss of vision and blood pressure of 230/140 mm Hg. Fundoscopy
showed papilledema with soft exudates in both eyes. Chemical studies
were positive and imaging revealed a left adrenal pheochromocytoma.
Despite aggressive medical treatment, fetal distress mandated a laparotomy
at the end of the 28th week of pregnancy. A healthy newborn was delivered
and resection of the adrenal tumor confirmed the diagnosis of pheochromocytoma.
CONCLUSIONS: Although rare, pheochromocytoma can cause severe peripartum
hypertension. Screening for pheochromocytoma, ideally with plasma-free
metanephrines, should be considered in cases of peripartum hypertension. |
