Dr Anna Hunt1, Dr Katherine Griffin2
1Gold Coast University Hospital, Southport, Australia, 2Gold Coast University Hospital, Southport, Australia
Biography:
Biographies to come
Abstract:
A 29-year-old primigravida presented with a bladder mass identified on first trimester ultrasound scan. Her history was notable for headache, crushing central chest pain and presyncope following micturition, most notable following her first void of the day. Investigation prior to pregnancy with 24-hour Holter monitor had been unremarkable, and clinic blood pressures had been normal.
Flexible cystoscopy confirmed a submucosal bladder lesion. Subsequent MRI pelvis confirmed a 33 x 16 x 25mm mass within the bladder wall, without evidence of lymphadenopathy or lesions elsewhere in the pelvis. Plasma normetanephrines were raised at 3840pmol/L, and 24hour urine catecholamines showed elevated noradrenaline, normetadrenaline and vanillylmandelic acid (VMA).
This case provides insights into the diagnostic evaluation of paraganglioma (PPGL) in pregnancy, and potential misconceptions regarding the safety of the clonidine suppression test. We will also discuss the perioperative management of PPGL of the bladder in pregnancy.
Keywords
Paraganglioma, clonidine suppression, pregnancy
References
Lenders, J. W. M., Langton, K., Langenhuijsen, J. F., & Eisenhofer, G. (2019). Pheochromocytoma and Pregnancy. Endocrinology and metabolism clinics of North America, 48(3), 605–617. https://doi.org/10.1016/j.ecl.2019.05.006
Queensland Clinical Guidelines. (2021). Queensland Clinical Guideline: Hypertension and Pregnancy. www.health.qld.gov.au/__data/assets/pdf_file/0034/139948/g-hdp.pdf
Briggs, G. G., Freeman, R. K., Towers, C. V., & Forinash, A. B. (2017). Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Eleventh edition. Philadelphia, PA, Wolters Kluwer.