Our Summary

This research paper discusses a rare but dangerous condition called pheochromocytoma that can occur during pregnancy. This condition can be hard to diagnose because its symptoms are not specific and can be confused with high blood pressure related to pregnancy. The best way to diagnose this condition is by measuring certain substances in the blood or urine. MRI scans are more useful than ultrasound scans in these cases. The best time to remove the tumor causing this condition is before the 24th week of pregnancy or after childbirth. Before surgery, the patient should receive medication. It’s usually safer for these patients to give birth via cesarean section, but vaginal delivery can be considered in some cases if the patient has been pre-treated.

FAQs

  1. What is the preferred method for diagnosing pheochromocytoma during pregnancy?
  2. When is the optimal time for surgical removal of pheochromocytoma during pregnancy?
  3. What type of delivery is preferred for patients with pheochromocytoma?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adrenalectomy is to follow all preoperative instructions carefully, including any medical pretreatment that may be recommended. It is important to discuss the timing of the surgery in relation to pregnancy, as well as the preferred method of delivery. Adherence to these recommendations can help ensure the best possible outcome for both the mother and the fetus.

Suitable For

Patients who are typically recommended for adrenalectomy include those with:

  1. Pheochromocytoma or paraganglioma, especially if the tumor is causing symptoms such as high blood pressure, palpitations, sweating, and headache.
  2. Patients with adrenal tumors that are hormone-producing, such as aldosterone-producing adenomas or cortisol-producing adenomas.
  3. Patients with large adrenal tumors that are causing compression symptoms on surrounding organs.
  4. Patients with suspected or confirmed adrenal cancer.
  5. Patients with multiple endocrine neoplasia type 2 (MEN2) or other hereditary syndromes that increase the risk of developing adrenal tumors.

It is important for these patients to be evaluated by a multidisciplinary team, including endocrinologists, surgeons, and anesthesiologists, to determine the best course of treatment and timing for surgery.

Timeline

Before adrenalectomy:

  • Patient may present with symptoms such as hypertension, episodic headaches, palpitations, sweating, and anxiety
  • Diagnosis is confirmed through measurements of plasma or urinary free metanephrines
  • Imaging studies such as MRI are performed to locate the tumor
  • Medical pretreatment may be necessary to stabilize blood pressure before surgery

After adrenalectomy:

  • Laparoscopic adrenalectomy is performed to remove the tumor
  • Patient may experience a decrease in symptoms such as hypertension and palpitations
  • Close monitoring of blood pressure and hormone levels is necessary post-surgery
  • Cesarean delivery is often preferred for pregnant patients with pheochromocytoma
  • Vaginal delivery may be considered in select cases after medical pretreatment and careful monitoring

What to Ask Your Doctor

  1. What is the reason for recommending an adrenalectomy in my case?
  2. What are the potential risks and complications associated with the procedure?
  3. How will the surgery be performed (open surgery vs. laparoscopic surgery)?
  4. What is the expected recovery time after the surgery?
  5. Will I need any special medications or treatments before or after the adrenalectomy?
  6. How will the adrenalectomy affect my hormone levels and overall health?
  7. What follow-up care will be needed after the surgery?
  8. How will the adrenalectomy impact my ability to have children in the future?
  9. Are there any long-term effects or considerations I should be aware of after the surgery?
  10. What are the chances of the pheochromocytoma returning after the adrenalectomy?

Reference

Authors: Lenders JWM, Langton K, Langenhuijsen JF, Eisenhofer G. Journal: Endocrinol Metab Clin North Am. 2019 Sep;48(3):605-617. doi: 10.1016/j.ecl.2019.05.006. Epub 2019 Jun 13. PMID: 31345526