If the woman is known to have a pheochromocytoma prior to pregnancy then often the tumor can be removed before the woman becomes pregnant. If the tumor cannot be removed then many findings can be controlled with medications (with alpha and beta adrenergic blockade).
The greatest risk occurs when the pheochromocytoma is unsuspected and one or more of the following results in a massive release of catecholamines:
(1) intra-abdominal pressure of a second or third trimester pregnancy
(2) labor, especially if difficult
(3) anesthesia
(4) medications
(5) trauma
Pheochromocytoma may show:
(1) paroxysmal hypertension
(2) otherostatic hypotension
(3) headaches
(4) flushing
(5) palpitations
(6) hyperglycemia
(7) no bipedal edema
The hypertension of pheochromocytoma may be misdiagnosed as preeclampsia or toxemia of pregnancy. The elevated blood glucose may be misdiagnosed as gestational diabetes.
The diagnosis can be made using:
(1) MRI
(2) urine snd plasma metanephrine
Some women diagnosed during pregnancy can undergo laparoscopic resection of the tumor. A tumor diagnosed during the third trimester may be resected during a cesarean section.
The fetus may die in utero or show growth retardation. Cesarean section may be safer than vaginal delivery after labor.
