| REVIEW TOPIC: ENDOCRINE DISORDERS IN PREGNANCY Phaeochromocytoma and pregnancy:a deceptive connection. | |
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MedLine Citation:
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PMID: 21890650 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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A phaeochromocytoma in a pregnant patient is one of the most threatening medical conditions for both mother, fetus and physician. Although extraordinarily rare with a frequency of 0.002% of all pregnancies, this tumour is notorious for its devastating consequences. As in non-pregnant patients, signs and symptoms are quite variable but not specific with hypertension as one of the most prominent signs. Confusion with the much more prevalent forms of pregnancy-related hypertension is the main cause of overlooking the diagnosis. If undiagnosed, maternal and fetal mortality is around 50%. Conversely, early detection and proper treatment during pregnancy decreases maternal and fetal mortality to less than 5% and 15% respectively. For the biochemical diagnosis plasma or urinary metanephrines are the tests of first choice since they have a nearly maximal negative predictive value. For reliable localisation, only MRI is suitable with a sensitivity of more than 90%.When the tumour is diagnosed in the first 24 weeks of gestation, it should be removed by laparoscopic adrenalectomy after 10-14 days medical preparation with the same drugs as in non-pregnant patients. If the tumour is diagnosed in the third trimester, the patients should be managed until the fetus is viable using the same drug regimen as for regular surgical preparation. Caesarean section with tumour removal in the same session or at a later stage is then preferred since vaginal delivery is possibly associated with higher mortality.Despite all technical diagnostic and therapeutical progress over the last decades, the key factor for further reduction of maternal and fetal mortality is early awareness and recognition of the potential presence of a phaeochromocytoma in a pregnant patient with hypertension. |
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Authors:
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Jwm Lenders |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-2 |
Journal Detail:
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Title: European journal of endocrinology / European Federation of Endocrine Societies Volume: - ISSN: 1479-683X ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-5 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423848 Medline TA: Eur J Endocrinol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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J Lenders, Departemnt of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, 6525GA, Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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