title: From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia.
abstract: Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features. Her initial presentation in hypertensive crisis with other symptoms led to diagnostic workup for secondary causes of hypertension and led to eventual diagnosis of paraganglioma. Obtaining this diagnosis prior to delivery was essential, as this led to prompt multidisciplinary care, changed the course of her clinical management, and ultimately enabled good maternal and fetal outcomes. This case highlights the importance of maintaining a high index of suspicion for secondary causes of hypertension and in obstetric patients and providing timely multidisciplinary care.
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Sasima
authors.identifier: 0000-0002-4031-5379
authors.initials: S
authors.lastname: Dusitkasem
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Blair H
authors.initials: BH
authors.lastname: Herndon
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Dalton
authors.initials: D
authors.lastname: Paluzzi
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kuhn
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Robert H
authors.identifier: 0000-0001-6362-9437
authors.initials: RH
authors.lastname: Small
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: John C
authors.identifier: 0000-0001-9245-8585
authors.initials: JC
authors.lastname: Coffman