title: Paroxysmal hypertension, pheochromocytoma, and pregnancy.
abstract: BACKGROUND
  Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality.
  
  
  METHODS
  A patient with severe hypertension, postpartum pulmonary edema, and a recognized pheochromocytoma is described.
  
  
  RESULTS
  Abdominal palpation after vaginal childbirth reproduced the diagnostic triad of hypertension, headaches, and palpitations. Magnetic resonance imaging established the correct diagnosis before biochemical confirmation of excess catecholamine production. The patient responded to alpha-adrenergic receptor blockade with control of her severe hypertension and clearing of pulmonary edema. The best time to diagnose a pheochromocytoma is before delivery because vaginal childbirth stimulates the release of lethal amounts of catecholamines.
  
  
  CONCLUSIONS
  The physician who delivers babies must distinguish between labile hypertension and paroxysmal hypertension. Most experts believe that a spontaneous vaginal delivery is contraindicated when the patient has a pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma is unusual. The profound pressor response elicited by palpation of the postpartum abdomen, the failure of medications usually effective in the treatment of a hypertensive crisis, and the use of magnetic resonance imaging to confirm a functioning adrenal adenoma are the features unique to this case.
authors: Department of Family Medicine, University of Tennessee, Jackson, USA.
authors: David J
authors: DJ
authors: Lyman
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000628:therapy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D011654:Pulmonary Edema / Q000150:complications / Q000188:drug therapy; D014481:United States
chemical_list: D000317:Adrenergic alpha-Antagonists