Document Detail

Paroxysmal hypertension, pheochromocytoma, and pregnancy.
MedLine Citation:
PMID:  12002199     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. METHODS: A patient with severe hypertension, postpartum pulmonary edema, and a recognized pheochromocytoma is described. RESULTS: Abdominal palpation after vaginal childbirth reproduced the diagnostic triad of hypertension, headaches, and palpitations. Magnetic resonance imaging established the correct diagnosis before biochemical confirmation of excess catecholamine production. The patient responded to alpha-adrenergic receptor blockade with control of her severe hypertension and clearing of pulmonary edema. The best time to diagnose a pheochromocytoma is before delivery because vaginal childbirth stimulates the release of lethal amounts of catecholamines. CONCLUSIONS: The physician who delivers babies must distinguish between labile hypertension and paroxysmal hypertension. Most experts believe that a spontaneous vaginal delivery is contraindicated when the patient has a pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma is unusual. The profound pressor response elicited by palpation of the postpartum abdomen, the failure of medications usually effective in the treatment of a hypertensive crisis, and the use of magnetic resonance imaging to confirm a functioning adrenal adenoma are the features unique to this case.
David J Lyman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of the American Board of Family Practice / American Board of Family Practice     Volume:  15     ISSN:  0893-8652     ISO Abbreviation:  J Am Board Fam Pract     Publication Date:    2002 Mar-Apr
Date Detail:
Created Date:  2002-05-10     Completed Date:  2002-09-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8807505     Medline TA:  J Am Board Fam Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  153-8     Citation Subset:  IM    
Department of Family Medicine, University of Tennessee, Jackson, USA.
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MeSH Terms
Adrenal Gland Neoplasms / complications,  diagnosis*,  surgery
Adrenergic alpha-Antagonists / therapeutic use
Hypertension / complications,  diagnosis*,  drug therapy
Magnetic Resonance Imaging
Pheochromocytoma / complications,  diagnosis*,  surgery
Pregnancy Complications, Cardiovascular / diagnosis*,  therapy
Pregnancy Complications, Neoplastic / diagnosis*,  surgery,  therapy
Pulmonary Edema / complications,  drug therapy
United States
Reg. No./Substance:
0/Adrenergic alpha-Antagonists

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