title: Pheochromocytoma in a Pregnant Woman With Prior Traumatic Aortic Injury.
abstract: BACKGROUND
  Pheochromocytoma, a catecholamine-producing tumor seldom encountered in pregnancy, is often heralded by nonspecific symptoms and undue mortality with delayed diagnosis. The presence of an aortic pseudoaneurysm poses a management challenge given the risk of aortic rupture amplified by hypertensive events.
  
  
  METHODS
  A 30-year-old woman, gravida 3 para 1, presented at 23 6/7 weeks of gestation with vomiting, chest pain, and severe hypertension. Investigation revealed adrenal pheochromocytoma and pseudoaneurysm at the site of a previous aortic injury. Prazosin and phenoxybenzamine achieved α-blockade with subsequent addition of labetalol for β-blockade. Concerns for aortic dissection led to endovascular aortic repair at 30 2/7 weeks of gestation. A female neonate was delivered by urgent cesarean delivery for persistent postprocedure fetal bradycardia. An adrenalectomy followed with near-immediate symptom resolution. Mother and neonate remain well.
  
  
  CONCLUSIONS
  The case underscores the necessity of a meticulous approach to hypertension management and the pivotal role of diligent multidisciplinary collaboration to achieve a safe outcome.
authors.affiliation: Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, and the Department of Medicine, Obstetric Medicine Program, University of Toronto, Mount Sinai Hospital, and the Department of Surgery, University of Toronto, Division of Vascular Surgery, Peter Munk Cardiac Centre and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Ann Kinga
authors.initials: AK
authors.lastname: Malinowski
authors.forename: Cynthia
authors.initials: C
authors.lastname: Maxwell
authors.forename: Mathew
authors.initials: M
authors.lastname: Sermer
authors.forename: Barry
authors.initials: B
authors.lastname: Rubin
authors.forename: Shital
authors.initials: S
authors.lastname: Gandhi
authors.forename: Candice K
authors.initials: CK
authors.lastname: Silversides
mesh_terms: D000310:Adrenal Gland Neoplasms; D000328:Adult; D017541:Aneurysm, False / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D010673:Pheochromocytoma; D011247:Pregnancy; D011248:Pregnancy Complications