title: ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature.
abstract: Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: van der Weerd
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Noord
authors.affiliation: Department of Anesthesiology, Unit of Obstetric Anesthesiology.
authors.forename: M
authors.initials: M
authors.lastname: Loeve
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands.
authors.forename: M F C M
authors.initials: MFCM
authors.lastname: Knapen
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Visser
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: W W
authors.initials: WW
authors.lastname: de Herder
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Franssen
authors.affiliation: Department of Anesthesiology, Unit of Obstetric Anesthesiology.
authors.forename: C D
authors.initials: CD
authors.lastname: van der Marel
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Feelders
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods; D010673:Pheochromocytoma / Q000000981:diagnostic imaging* / Q000628:therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000178:diet therapy* / Q000628:therapy
chemical_list: D000317:Adrenergic alpha-Antagonists