PMM.37 Undiagnosed Pheochromocytoma in Labour – Would you suspect it?

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Abstract

Aims/Objectives

This is a case presentation aiming to draw attention to the clinical suspicious of pheochromocytoma as a differential of severe hypertension in labour.

Background

Pheochromocytoma in a pregnant woman is extremely rare (1:54,000 pregnancies)1 but life threatening condition. The signs and symptoms are variable, with hypertension being one of the most prominent. Maternal and fetal mortality is around 50%. Plasma or urinary metanephrines are the tests of choice with MRI for localisation. If suspected, Caesarean section is preferred since vaginal delivery is associated with higher mortality.2

Background

44 year-old-lady, Para 4 diagnosed with Essential Hypertension since the age of 18 presented to Labour Ward at 34 weeks for IOL due to PPROM at 26 weeks. She was on multiple anti-hypertensives prior to and during her pregnancy with controlled BP. During the second stage of labour the junior doctor observed a BP of 204/130 despite Labetalol, Hydralazin and epidural. In view of her BP, Caesarean Section was performed and a healthy baby was delivered. Post-delivery BP continued to be unstable and increased plasma adrenalin prompted the diagnosis and referral to Endocrinologist.

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