Management of pregnant women with pheochromocytoma: clinical cases and literature review

Abstract

Objective. To represent clinical cases of pheochromocytoma (PCC) during pregnancy and to draw attention to diagnostics, choice of proper treatment and delivery method. Design and methods. Both domestic and forensic scientific and medical publications about hypertension and PCC were analyzed. We also represent four clinical cases of the patients with PCC, who were observed and treated in Perinatal Centre of Almazov National Medical Research Centre. Results. In three cases hypertension had been diagnosed before present pregnancy, and in two cases it had been treated as essential hypertension. One woman registered increased blood pressure (BP) during pregnancy for the first time. In three cases hypertensive crises were registered. Two caesarian sections were performed because of fetoplacental circulation disorders and high risks of antenatal fetal death, both before full term. Two natural births occurred at full term and at 34 weeks due to the development of spontaneous labor. In all cases PCC was diagnosed during pregnancy, confirmed by histology and immunohistochemistry after adrenalectomy in the postpartum period. Conclusions. All patients with PCC during pregnancy must be followed by a multidisciplinary team including obstetricians, cardiologists, endocrinologists, surgeons, anesthesiologists and neonathologists. Early diagnosis and proper treatment significantly improve prognosis during pregnancy for both mother and fetus. Specialists must exclude PCC if any urgent cardiovascular situation developed during pregnancy, including first detection of increased BP.