INTRODUCTION
Pheochromocytoma is a catecholamine-secreting tumour that arises from
the medullary portion of the adrenal gland or the sympathetic ganglia’s
chromaffin cells. It is one of the causes of secondary hypertension that
affects 0.2 to 0.4% of people and can cause a severe or fatal
hypertensive crisis. During pregnancy, it affects about 1 in 50,000 of
women. A timely diagnosis and adequate care of this condition can reduce
maternal and fetal mortality and morbidity from over 50% to less than
5% and 15%, respectively 1 .
When significant hypertension arises before 20 weeks of pregnancy and
blood pressure (BP) is labile with episodic headaches, palpitations, or
sweating, pheochromocytoma should be one of the top differential
diagnoses 2 .
However, pheochromocytoma may not show any signs or symptoms during
pregnancy, and is far less common than other causes of hypertension in
pregnant women. Specific symptoms including paroxysmal sweating,
palpitation, and blood pressure crises are also likely to be less
prevalent in pregnant women than in non-pregnant women. According to a
review of the literature, 90 % of pregnant women experience
pheochromocytoma symptoms just before delivery3 .
The diagnosis is usually established by detecting high levels of
catecholamines and their metabolites in plasma and urine. Where the
fetus must be protected, ultrasonography and magnetic resonance imaging
(MRI) are the most suitable modalities of tumour localization during
pregnancy. Pheochromocytoma is treated medically with alpha-adrenergic
blockade to regulate hypertension and beta-adrenergic blocker to treat
tachycardia and cardiac dysrhythmias. The only way to cure
pheochromocytoma is to remove the tumour surgically4 .