PHEOCHROMOCYTOMA IN PREGNANCY

Pheochromocytoma in pregnancy can cause the death of both the fetus and the mother.

The approach to the biochemical diagnosis is the same as for the nonpregnant patient. MRI is the preferred imaging modality, and 123I-MIBG is contraindicated.

The treatment of hypertensive crises is the same as for nonpregnant patients except that use of nitroprusside should be avoided.

Although the most appropriate management is debated, adrenal pheochromocytomas should be removed promptly if diagnosis is made during the first two trimesters of pregnancy. The preoperative preparation is the same as for a nonpregnant patient. If the pregnancy is in the third trimester, one operation is recommended for a cesarean delivery and removal of the adrenal pheochromocytoma at the same time. Spontaneous labor and delivery should be avoided. The management of catecholamine-secreting paragangliomas in pregnancy may require modification of these guidelines, depending on tumor location.