What are the treatments options for pheochromocytomas during pregnancy?

Updated: Aug 10, 2018
  • Author: Michael A Blake, MBBCh, MRCPI, FRCR; Chief Editor: George T Griffing, MD  more...
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Answer

If pheochromocytoma is found during pregnancy, initiate alpha-adrenergic blockade (with phenoxybenzamine) as soon as the diagnosis is confirmed. Remove the tumor by laparoscopic adrenalectomy as soon as possible during the first 2 trimesters, after proper preparation. Pregnancy need not be terminated. Spontaneous abortion is very likely, however.

During the third trimester, the patient should be managed medically until fetal lung maturity is confirmed. Cesarean delivery is preferred, as mortality may be higher with vaginal delivery. The tumor may be removed during the same session as the cesarean section, or it can be removed postpartum. [28]

A study by Donatini et al suggested that in pregnant women with bilateral pheochromocytomas, unilateral adrenalectomy for the larger tumor during pregnancy may be a useful strategy to avoid adrenal insufficiency, with contralateral adrenalectomy performed a few months after delivery. [63]


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