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Paraganglioma in pregnancy, a mimic of preeclampsia: a case report

BACKGROUND: The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. CASE PRESENTATION: We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new on...

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Autores principales: Lundholm, Michelle D., Marquard, Jessica, Rao, Pratibha PR
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080865/
https://www.ncbi.nlm.nih.gov/pubmed/37024931
http://dx.doi.org/10.1186/s13256-023-03871-8
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author Lundholm, Michelle D.
Marquard, Jessica
Rao, Pratibha PR
author_facet Lundholm, Michelle D.
Marquard, Jessica
Rao, Pratibha PR
author_sort Lundholm, Michelle D.
collection PubMed
description BACKGROUND: The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. CASE PRESENTATION: We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new onset hypertension associated with headaches, dry heaves, diaphoresis, and palpitations. She was initially diagnosed with preeclampsia and treated with labetalol and an urgent cesarean section, delivering a healthy baby girl. The diagnosis of preeclampsia came into question when, 6 weeks postpartum, she continued to have hypertension with atypical features. Testing revealed metastatic paraganglioma associated with a succinate dehydrogenase B gene mutation. The patient was then started on alpha-adrenergic blockade and has had close blood pressure monitoring while discussion of advances therapies is ongoing. CONCLUSION: This case demonstrates how paraganglioma/pheochromocytoma can be misdiagnosed as preeclampsia due to the overlapping features of new-onset hypertension late in pregnancy accompanied by headache and proteinuria. It is impractical to routinely screen for paraganglioma/pheochromocytoma in all pregnant patients diagnosed with preeclampsia due to the rarity of these tumors and the harm from high false-positive rates. Therefore, it is incumbent on the provider to have a high degree of suspicion for paraganglioma/pheochromocytoma when clinical features are unusual for preeclampsia, such as intermittent palpitations, diaphoresis, orthostatic hypotension, or hyperglycemia. Early detection of paraganglioma/pheochromocytoma with interventions to mitigate the risk of hypertensive crisis greatly reduce maternal and fetal mortality. Fortunately, our patient delivered a healthy baby and did not have any additional pregnancy complications despite the delay in her diagnosis.
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spelling pubmed-100808652023-04-08 Paraganglioma in pregnancy, a mimic of preeclampsia: a case report Lundholm, Michelle D. Marquard, Jessica Rao, Pratibha PR J Med Case Rep Case Report BACKGROUND: The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. CASE PRESENTATION: We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new onset hypertension associated with headaches, dry heaves, diaphoresis, and palpitations. She was initially diagnosed with preeclampsia and treated with labetalol and an urgent cesarean section, delivering a healthy baby girl. The diagnosis of preeclampsia came into question when, 6 weeks postpartum, she continued to have hypertension with atypical features. Testing revealed metastatic paraganglioma associated with a succinate dehydrogenase B gene mutation. The patient was then started on alpha-adrenergic blockade and has had close blood pressure monitoring while discussion of advances therapies is ongoing. CONCLUSION: This case demonstrates how paraganglioma/pheochromocytoma can be misdiagnosed as preeclampsia due to the overlapping features of new-onset hypertension late in pregnancy accompanied by headache and proteinuria. It is impractical to routinely screen for paraganglioma/pheochromocytoma in all pregnant patients diagnosed with preeclampsia due to the rarity of these tumors and the harm from high false-positive rates. Therefore, it is incumbent on the provider to have a high degree of suspicion for paraganglioma/pheochromocytoma when clinical features are unusual for preeclampsia, such as intermittent palpitations, diaphoresis, orthostatic hypotension, or hyperglycemia. Early detection of paraganglioma/pheochromocytoma with interventions to mitigate the risk of hypertensive crisis greatly reduce maternal and fetal mortality. Fortunately, our patient delivered a healthy baby and did not have any additional pregnancy complications despite the delay in her diagnosis. BioMed Central 2023-04-07 /pmc/articles/PMC10080865/ /pubmed/37024931 http://dx.doi.org/10.1186/s13256-023-03871-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Lundholm, Michelle D.
Marquard, Jessica
Rao, Pratibha PR
Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title_full Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title_fullStr Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title_full_unstemmed Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title_short Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
title_sort paraganglioma in pregnancy, a mimic of preeclampsia: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080865/
https://www.ncbi.nlm.nih.gov/pubmed/37024931
http://dx.doi.org/10.1186/s13256-023-03871-8
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