PM.90 Incidental Phaeochromocytoma in Pregnancy

Abstract

Background Phaeochromocytoma, a catecholamine-producing endocrine tumour, is a life-threatening condition to the mother and fetus. The incidence of phaeochromocytoma in pregnancy is extremely rare, 1 in 54 000 pregnancies. If it remains undiagnosed and untreated, maternal and fetal mortality amounts to 40-50%. Classically, physicians search for the tumour in hypertensive patients with paroxysmal symptoms such as headache, sweating or palpitations. However, our patient presented atypically and would have been left undiagnosed. Case A 21-year-old presented after a fall at 24 weeks of gestation, with loin pain on the contralateral side to the fall while on holiday. This prompted an ultrasound scan that demonstrated a 9 cm 'haematoma' above the right kidney. As she was claustrophobic, she declined magnetic resonance imaging (MRI). When she came back to the local hospital, a repeat ultrasound was performed which showed the mass to be unchanged. Suspicion arose and an MRI under sedation was performed after discussion with the radiologist as MRI is recommended to look for adrenal/renal mass in pregnancy. This confirmed an 8 × 7 cm mass superior to the right kidney. Her case was discussed in a multi-disciplinary team sarcoma meeting, which concluded she should be tested biochemically for phaeochromocytoma and not to have renal biopsy as there is a high risk of crisis. An endocrinologist reviewed her and serum and urine biochemistry investigations were performed. Her urinary 3-methoxytyramine and serum dopamine levels were raised indicating possible phaeochromocytoma. She did not need a-adrenoceptor blockade, as she remained asymptomatic throughout her pregnancy. She was referred to a tertiary hospital where an elective caesarean section was performed. She then had a separate surgical removal of the phaeochromocytoma. Conclusion Diagnosing phaeochromocytoma in an asymptomatic pregnant patient is challenging. If left undiagnosed and untreated, the transient excessive maternal levels of catecholamines may have deleterious effects on the uteroplacental circulation and cause placental abruption and intrauterine hypoxia. In our patient, however, when diagnosed, a multi-disciplinary team approach with the obstetrician, surgeon and endocrinologist is vital in the management of this rare disorder.