title: Peripartum hypertension from pheochromocytoma: a rare and challenging entity.
abstract: 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.
  
  
  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.
authors.affiliation: 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.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Kamari
authors.forename: Yehonatan
authors.initials: Y
authors.lastname: Sharabi
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.forename: Edna
authors.initials: E
authors.lastname: Peleg
authors.forename: Sara
authors.initials: S
authors.lastname: Apter
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D004452:Echocardiography; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000209:etiology*; D007813:Laparotomy; D008279:Magnetic Resonance Imaging; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000209:etiology; D012186:Retroperitoneal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000601:surgery