Dr Georgia Sheedy1
1Obstetric Medicine Service, Gold Coast University Hospital, Southport, Australia
Biography:
Biographies to come
Abstract:
Phaeochromocytoma cardiomyopathy is an extremely rare finding during pregnancy and can mimic more common causes of acute cardiorespiratory failure such as pulmonary embolism, pre-eclampsia or peripartum cardiomyopathy (1). Here, we report an unusual case of a previously healthy 31-year-old primigravida presenting with intra-partum acute pulmonary oedema and dilated cardiomyopathy, later found to be due to an undiagnosed phaeochromocytoma.
She presented at term with premature rupture of membranes and was diagnosed with pre-eclampsia in the setting of new onset hypertension and elevated creatinine. During labour she became severely hypoxic, with examination and chest x-ray findings consistent with pulmonary oedema with cardiomegaly. A point of care trans-thoracic echocardiogram confirmed dilated cardiomyopathy with a left ventricular ejection fraction of 35%, leading to a provisional diagnosis of peri-partum cardiomyopathy. Further maternal deterioration prompted emergent caesarean section under general anaesthesia, and a healthy male infant was delivered. She was admitted to the intensive care unit post-operatively where she was noted to have fluctuating haemodynamics and fever. An abdominal CT showed a large left adrenal mass, and the diagnosis of phaeochromocytoma was confirmed with significantly elevated plasma metanephrines. She was treated with two weeks of alpha blockade followed by beta blockade with complete recovery of cardiac function and was discharged from hospital one month later with good functional recovery. Surgical outcomes and results of genetic testing are awaited.
This case demonstrates an intra-partum presentation of phaeochromocytoma crisis with catecholaminergic cardiomyopathy, and highlights some of the diagnostic and management challenges of phaeochromocytoma in the pregnant and postpartum patient.
Keywords
Phaeochromocytoma, pregnancy, cardiomyopathy
References
Itagane
M, Nakazato J, Kinjo M. Postpartum pheochromocytoma-induced takotsubo syndrome. BMJ Case Reports [Internet]. 2021 Mar 1;14(3
):e
240098. Available from: https://doi.org/10.1136/bcr-2020-240098