Paraganglioma in pregnancy, a mimic of preeclampsia: a case report
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-03871-8 |
| _version_ | 1797850035375833088 |
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| author | Michelle D. Lundholm Jessica Marquard Pratibha PR Rao |
| author_facet | Michelle D. Lundholm Jessica Marquard Pratibha PR Rao |
| author_sort | Michelle D. Lundholm |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-09T18:53:53Z |
| format | Article |
| id | doaj.art-6fd87081aacd485395c8a1c56334f2e4 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-09T18:53:53Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-6fd87081aacd485395c8a1c56334f2e42023-04-09T11:17:25ZengBMCJournal of Medical Case Reports1752-19472023-04-011711610.1186/s13256-023-03871-8Paraganglioma in pregnancy, a mimic of preeclampsia: a case reportMichelle D. Lundholm0Jessica Marquard1Pratibha PR Rao2Department of Endocrinology, Diabetes and Metabolism Cleveland ClinicCenter for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland ClinicDepartment of Endocrinology, Diabetes and Metabolism Cleveland ClinicAbstract 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.https://doi.org/10.1186/s13256-023-03871-8ParagangliomaPheochromocytomaPregnancy careHypertensionCase report |
| spellingShingle | Michelle D. Lundholm Jessica Marquard Pratibha PR Rao Paraganglioma in pregnancy, a mimic of preeclampsia: a case report Journal of Medical Case Reports Paraganglioma Pheochromocytoma Pregnancy care Hypertension 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 | Paraganglioma Pheochromocytoma Pregnancy care Hypertension Case report |
| url | https://doi.org/10.1186/s13256-023-03871-8 |
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