Hypertension Grand Rounds Pheochromocytoma in Pregnancy A Case Series and Review

Hypertensive disorders in pregnancy remain among the most understudied areas despite the recent advancement in medical care and management.1 Although most of this is ascribed to a pregnancy-specific disorder, preeclampsia, there is a paucity of data and few recommendations about another potentially disastrous hypertensive disorder, pheochromocytoma, a catecholamine producing tumor, with a reported incidence of 0.2 per 10 000 pregnancies.2 Despite its rarity, untreated pheochromocytomas carry a risk of mortality for both mother and fetus, as high as 58%.3 This may be attributed to several factors, such as the failure to detect the condition because of its extreme rarity, the tendency of these tumors to have varied presentations, and the fact that pregnancy may preclude certain imaging modalities and radioisotope testing.2,4,5 The enlarging uterus may also trigger tumor activity, in addition to the tendency for gravidas to undergo operative procedures on short notice.6 Thus, it is imperative that physicians who manage patients with pheochromocytoma familiarize themselves with special considerations in relation to pheochromocytoma during pregnancy. Focus should be directed toward understanding the indications of when women with chronic or de novo hypertension during gestation should undergo the special tests used to diagnose pheochromocytoma and how to manage the disease once diagnosed. This report surveys 6 pheochromocytomas managed at our institution, reviews the literature of pheochromocytomas, and presents recommendations on how to better suspect, detect, and manage these disorders in pregnant populations.