Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency
Purpose Pheochromocytoma, a catecholamine-secreting tumour leading to neurological and cardiovascular life-threatening conditions through hypertension crisis, occurs in 0.1-0.5% of hypertensive patients, but it is extremely rare in pregnancy (0.0018-0.006%). Some classes of drugs, even commonly used...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2021-09-01
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| Series: | Blood Pressure |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08037051.2021.1945428 |
| _version_ | 1827817838825439232 |
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| author | Aurelio Negro Ignazio Verzicco Stefano Tedeschi Rosaria Santi Barbara Palladini Anna Calvi Alessandro Giunta Davide Cunzi Pietro Coghi Riccardo Volpi Aderville Cabassi |
| author_facet | Aurelio Negro Ignazio Verzicco Stefano Tedeschi Rosaria Santi Barbara Palladini Anna Calvi Alessandro Giunta Davide Cunzi Pietro Coghi Riccardo Volpi Aderville Cabassi |
| author_sort | Aurelio Negro |
| collection | DOAJ |
| description | Purpose Pheochromocytoma, a catecholamine-secreting tumour leading to neurological and cardiovascular life-threatening conditions through hypertension crisis, occurs in 0.1-0.5% of hypertensive patients, but it is extremely rare in pregnancy (0.0018-0.006%). Some classes of drugs, even commonly used in pregnancy, can trigger catecholamine secretion, precipitating the clinical situation. Materials and Methods and Results We report a 33-year-old woman, gravida 2 para 1, with previous mild hypertension, was admitted to the emergency room, at 28 2/7 weeks of gestation due to headache, tachycardia and severe arterial hypertension (220/120 mm Hg) triggered by the antiemetic metoclopramide used for a week because of nausea. In the emergency room, a paradoxical rise in blood pressure followed intravenous labetalol infusion was observed. Both metoclopramide and labetalol-triggered hypertensive crisis raised the suspicion of an undiagnosed pheochromocytoma. Diagnostic work-up showed elevated normetanephrine urinary excretion and a right adrenal pheochromocytoma by abdominal magnetic resonance imaging. Oral alpha-1 and beta-1-adrenergic antagonist and calcium-channel blocker were started. At 33-weeks of gestation, she underwent a caesarean section giving birth to a female child. Seven weeks later she underwent a video-laparoscopic right adrenalectomy which normalised her blood pressure. Conclusions Both metoclopramide, a selective dopamine type-2 receptor antagonist and partial agonist of 5-hydroxytryptamine 4 receptor, and labetalol, a non-selective β-adrenoreceptor-blocker with weak α1-adrenergic antagonism, exacerbated an acute hypertensive crisis revealing an unrecognised pheochromocytoma in a pregnant patient. Careful attention to potential drug-triggered catecholamine crises and especially early recognition of pheochromocytomas, are mandatory in hypertensive pregnant women. A missed or delayed diagnosis could result in catastrophic results affecting foetal and maternal outcomes. |
| first_indexed | 2024-03-12T00:39:16Z |
| format | Article |
| id | doaj.art-8ed7eb68359c45e7a1825e12dfdc6f49 |
| institution | Directory Open Access Journal |
| issn | 0803-7051 1651-1999 |
| language | English |
| last_indexed | 2024-03-12T00:39:16Z |
| publishDate | 2021-09-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Blood Pressure |
| spelling | doaj.art-8ed7eb68359c45e7a1825e12dfdc6f492023-09-15T08:45:24ZengTaylor & Francis GroupBlood Pressure0803-70511651-19992021-09-0130532232610.1080/08037051.2021.19454281945428Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergencyAurelio Negro0Ignazio Verzicco1Stefano Tedeschi2Rosaria Santi3Barbara Palladini4Anna Calvi5Alessandro Giunta6Davide Cunzi7Pietro Coghi8Riccardo Volpi9Aderville Cabassi10Internal Medicine and Hypertension Center, Ospedale Sant'Anna di Castelnovo Ne' MontiUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaInternal Medicine and Hypertension Center, Ospedale Sant'Anna di Castelnovo Ne' MontiUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaOncological Surgery, Azienda Unità sanitaria Locale – IRCCS di Reggio EmiliaInternal Medicine and Hypertension Center, Ospedale Sant'Anna di Castelnovo Ne' MontiUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaUnità di Fisiopatologia Medica, Clinica e Terapia Medica, Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, University of ParmaPurpose Pheochromocytoma, a catecholamine-secreting tumour leading to neurological and cardiovascular life-threatening conditions through hypertension crisis, occurs in 0.1-0.5% of hypertensive patients, but it is extremely rare in pregnancy (0.0018-0.006%). Some classes of drugs, even commonly used in pregnancy, can trigger catecholamine secretion, precipitating the clinical situation. Materials and Methods and Results We report a 33-year-old woman, gravida 2 para 1, with previous mild hypertension, was admitted to the emergency room, at 28 2/7 weeks of gestation due to headache, tachycardia and severe arterial hypertension (220/120 mm Hg) triggered by the antiemetic metoclopramide used for a week because of nausea. In the emergency room, a paradoxical rise in blood pressure followed intravenous labetalol infusion was observed. Both metoclopramide and labetalol-triggered hypertensive crisis raised the suspicion of an undiagnosed pheochromocytoma. Diagnostic work-up showed elevated normetanephrine urinary excretion and a right adrenal pheochromocytoma by abdominal magnetic resonance imaging. Oral alpha-1 and beta-1-adrenergic antagonist and calcium-channel blocker were started. At 33-weeks of gestation, she underwent a caesarean section giving birth to a female child. Seven weeks later she underwent a video-laparoscopic right adrenalectomy which normalised her blood pressure. Conclusions Both metoclopramide, a selective dopamine type-2 receptor antagonist and partial agonist of 5-hydroxytryptamine 4 receptor, and labetalol, a non-selective β-adrenoreceptor-blocker with weak α1-adrenergic antagonism, exacerbated an acute hypertensive crisis revealing an unrecognised pheochromocytoma in a pregnant patient. Careful attention to potential drug-triggered catecholamine crises and especially early recognition of pheochromocytomas, are mandatory in hypertensive pregnant women. A missed or delayed diagnosis could result in catastrophic results affecting foetal and maternal outcomes.http://dx.doi.org/10.1080/08037051.2021.1945428metoclopramidepheochromocytomapregnancyhypertension emergencylabetalol |
| spellingShingle | Aurelio Negro Ignazio Verzicco Stefano Tedeschi Rosaria Santi Barbara Palladini Anna Calvi Alessandro Giunta Davide Cunzi Pietro Coghi Riccardo Volpi Aderville Cabassi Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency Blood Pressure metoclopramide pheochromocytoma pregnancy hypertension emergency labetalol |
| title | Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency |
| title_full | Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency |
| title_fullStr | Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency |
| title_full_unstemmed | Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency |
| title_short | Unrecognised pheochromocytoma in pregnancy discovered through metoclopramide-triggered hypertensive emergency |
| title_sort | unrecognised pheochromocytoma in pregnancy discovered through metoclopramide triggered hypertensive emergency |
| topic | metoclopramide pheochromocytoma pregnancy hypertension emergency labetalol |
| url | http://dx.doi.org/10.1080/08037051.2021.1945428 |
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