SAT-313 Catecholamine-Induced Cardiomyopathy in Pheochromocytoma during Pregnancy

Introduction: This case illustrates an uncommon initial presentation of cardiomyopathy in a pregnant woman who was later found to have Pheochromocytoma. Case: A 33-year-old female who is 19 weeks pregnant with no significant past medical or family history presented to the hospital with pleuritic chest pain associated with palpitations and dyspnea. Echocardiogram showed mildly dilated left ventricle with mild global left ventricular (LV) systolic dysfunction and an ejection fraction (EF) of 40-50%. Electrocardiogram (EKG) showed Q waves, with peak troponin of 1.8. Her symptoms were attributed to a post-viral perimyocarditis, was treated symptomatically and discharged home. She presented again at 22 weeks of pregnancy due to the same symptoms. Repeat echocardiogram showed improvement of cardiac function with normal EF and LV function; hence, she was once again treated symptomatically and discharged to home. The rest of her pregnancy was unremarkable. She carried to term and had an uncomplicated vaginal delivery. One week postpartum she presented to the hospital this time with complaints of intermittent headaches, episodic palpitations and new onset hypertension with systolic blood pressure (BP) in the 170s (<130mmHg). Pre pregnancy and BP during pregnancy were within normal limits. Diagnostic testing for secondary causes of hypertension were done which were all negative except for plasma catecholamines: metanephrine 24 nmol/L (<.50), normetanephrine 8.3nmol/L (<.9), epinephrine >1354 pg/ml (<642), and norepinephrine 2669 pg/ml (<642). 24 hour urine results showed: metanephrine 20 600mcg/24hr (<400), normetanephrine 3540 mcg/24hr (<900), total metanephrines 24 140 mcg/24hr (<1300), epinephrine 583 mcg/24hr(<21), norepinephrine 645 mcg/24hr (15-80). CT of the abdomen showed a 7.9x7x8.2 cm right adrenal mass. She underwent a laparoscopic right adrenalectomy and histopathology confirms the diagnosis of Pheochromocytoma. Her symptoms resolved after surgery with BP returning to normal. Repeat plasma catecholamines post surgery also returned to normal limits. Discussion: Pheochromocytoma during pregnancy is an extremely rare event with a reported incidence of .007% with an antepartum diagnosis that is only made 75% of the time (Van der Weerd et al., 2017). It is most often found during the third trimester of pregnancy and patients are more symptomatic during this time due to the compression of the enlarging gravid uterus on the tumor causing catecholamine release. Diagnosis is difficult especially in this case because the patient did not initially present with the classic symptoms until postpartum. Reference: Weerd, K. V., Noord, C. V., Loeve, M., Knapen, M. F., Visser, W., Herder, W. W., Feelders, R. A. (2017). ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: Case series and review of literature. European Journal of Endocrinology,177(2). doi:10.1530/eje-16-0920