Pseudopheochromocytoma of pregnancy.
OBJECTIVE
To report a diagnostically challenging case of preeclampsia.


METHODS
We present a case report with clinical, biochemical, imaging, and immunohistochemical findings. In addition, the clinical features of pheochromocytoma during pregnancy are reviewed, and the challenges in distinguishing it from preeclampsia are discussed.


RESULTS
A 33-year-old woman presented at 14 weeks' gestational age with severe hypertension. Evaluation for secondary causes of hypertension were prompted by difficulty controlling the blood pressure and associated symptoms of headache and nausea. Investigations revealed high levels of urinary catecholamines, in conjunction with increased uptake of (111)In-labeled octreotide in the midabdominal area. At 28 weeks' gestation, worsening of blood pressure, high liver enzyme levels, and proteinuria necessitated a cesarean delivery and concomitant hysterectomy. Blood pressure and urinary catecholamine excretion promptly normalized after delivery. Pathologic examination of the uterus and placenta demonstrated no expression of neuroendocrine markers including chromogranin, but the trophoblast demonstrated strong immunostaining for tyrosine hydroxylase. Expression of this rate-limiting enzyme responsible for catecholamine synthesis may have contributed to the pathogenesis of preeclampsia in this patient.


CONCLUSIONS
This case demonstrates that severe pre-eclampsia may mimic pheochromocytoma.
Department of Medicine, University of Toronto, Ontario, Canada.
Baiju R
BR
Shah
Shital
S
Gandhi
Sylvia L
SL
Asa
Shereen
S
Ezzat
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D010673:Pheochromocytoma / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011877:Radionuclide Imaging