title: Cardiorespiratory crisis at the end of pregnancy: a case of pheochromocytoma.
abstract: Pheochromocytoma during pregnancy is extremely rare. Its clinical manifestation includes hypertension with various clinical presentations, possibly resembling those of pregnancy-induced hypertension. The real challenge for clinicians is differentiating pheochromocytoma from other causes of hypertension (preeclampsia, gestational hypertension, and pre-existing or essential hypertension), from other cause of pulmonary edema (preeclampsia, peripartum cardiomyopathy, stress or Takotsubo cardiomyopathy, pre-existing cardiac disease [mitral stenosis], and high doses betamimetics), and from other causes of cardiovascular collapse (pulmonary embolism, and amniotic fluid embolism). Although, several cases of pheochromocytoma during pregnancy have been published, fetal and maternal mortalities due to undiagnosed cases are still reported. We report a case of a patient whose delivery by cesarean section was complicated by severe hemodynamic instability resulting in a cardiac arrest. Later on, pheochromocytoma was suspected based on computed tomography (CT) scan findings. Diagnosis was confirmed with special biochemical investigations that showed markedly elevated catecholamines in urine and metanephrines in serum, and later by histopathology of the excised left adrenal mass. This case illustrates the difficulty of diagnosing pheochromocytoma in pregnancy and raises the awareness to when this rare disease should be suspected.
authors.affiliation: Intensive Care Department, MC 1425, Surgical Intensive Care Unit, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. haddads55@yahoo.com
authors.forename: Samir
authors.initials: S
authors.lastname: Haddad
authors.forename: Basel
authors.initials: B
authors.lastname: Al-Raiy
authors.forename: Azza
authors.initials: A
authors.lastname: Madkhali
authors.forename: Saad
authors.initials: S
authors.lastname: Al-Qahtani
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Sultan
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002395:Catecholamines / Q000652:urine; D002585:Cesarean Section; D003937:Diagnosis, Differential; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008676:Metanephrine / Q000097:blood; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000601:surgery; D011263:Pregnancy Trimester, Third; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D002395:Catecholamines; D008676:Metanephrine