Images in Surgery| Volume 147, ISSUE 3, P459-461, March 2010

Cardiac paraganglioma presenting as gestational hypertension

Published:October 13, 2008DOI:
      This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. The images are accompanied by brief case reports (limit 2 typed pages, 4 references). Our readers are invited to sumit items for consideration.
      A 24-year-old woman presented to an outside hospital during her third trimester of pregnancy with hypertensive episodes (230/130 mm Hg), headaches, and palpitations. Pre-eclampsia was excluded because of the absence of proteinuria. Additional evaluation revealed markedly elevated 24-h urinary catecholamines (norepinephrine, 978 μg/24 h [0–100]; normetanephrine, 4067 μg/24 h [50–650]; epinephrine, <3 μg/24 h [0–25]; metanephrine, 108 μg/24 h [30–350]; and vanillylmandelic acid, 13.6 mg/d [0–7]), which confirmed the diagnosis of pheochromocytoma. A magnetic resonance image (MRI) of the abdomen showed a 2.8 × 1.9-cm mixed-intensity mass medial to the left adrenal gland, which was presumed to be a pheochromocytoma. The patient was brought to term safely on phenoxybenzamine therapy (10 mg twice daily), and a healthy baby was delivered via elective cesarean section. Postpartum, the patient underwent an elective left laparoscopic adrenalectomy. However, pathology revealed only normal adrenal tissue, and the patient's clinical syndrome did not resolve. Genetic testing for a RET proto-oncogene mutation was negative, and the patient was referred for additional evaluation.
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