PHEOCHROMOCYTOMA AND PREGNANCY - THE EPITOME OF HIGH-RISK

Background. Past review has shown that one half of the fetuses and nea rly that many mothers died of pheochromocytoma if the tumor was not de tected in the mother before delivery. The rarity of the occurrence add s to the potential danger because experience with diagnosis and manage ment is unusual. However, the diagnosis is straightforward when consid ered because pregnancy does not alter diagnostic levels of catecholami nes. Management must be individualized and can be done safely. Methods . The cases of five patients with pheochromocytomas during pregnancy a re presented here. Diagnosis was made by urinary catecholamine measure ment. Localization methods included caval catheterization and ultrason ography. Blood pressure control was done with alpha- and beta-adrenerg ic blockers. Treatment strategy was planned by a team of internists, o bstetricians, surgeons, and anesthesiologists. Results. All five mothe rs and three fetuses survived. The two fetal deaths were planned termi nations. Two mothers and one fetus had multiple endocrine neoplasia ty pe 2B syndrome. One mother had two recurrences, one of which was invol ved with the pregnancy. Conclusions. Pregnancy does not alter urinary catecholamine levels to confuse the diagnosis of pheochromocytoma. Loc alization by ultrasonography and magnetic resonance imaging is safe to the fetus. Alpha- And beta-adrenergic blockers are well tolerated. Ev ery effort should be made to save a normal fetus when the tumor is fir st discovered during the third trimester. Timing of excision is a deci sion best done by team planning.