article = {SCR-2018-3-116}
title = {Uneventful Cesarean Section in A Woman with Normotensive Asymptomatic Bifocal Pheochromocytoma Without Preoperative Alpha Blockade Preparation}
journal = {Surgical Case Reports}
year = {2018}
issn = {2613-5965}
doi = {http://dx.doi.org/10.31487/j.SCR.2018.03.016}
url = {https://www.sciencerepository.org/uneventful-cesarean-section-in-a-woman-with-normotensive-a-symptomatic-bifocal-pheochromocytoma-without-preoperative-alpha-blockade-preparation_SCR-3-116 
author = {Hassan  Shawa,Jamila A  Benmoussa,Sara Clark,}
keywords = {Normotensive, Pheochromocytoma, Pregnancy, c-section, preoperative, alpha blockade}
abstract ={Context: There are no guidelines on the management of pheochromocytoma (PCC) diagnosed
during pregnancy due to the rarity of the condition.
Case Description: A 30-year-old woman with MEN 2A due to a germline mutation in exon 11 of
the RET oncogene. She underwent a prophylactic total thyroidectomy at the age of 12 with
pathology showing multifocal microscopic medullary thyroid carcinoma. At the age of 20, she was
found to have elevated catecholamines and CT of the abdomen revealed a 2.1 cm left adrenal
pheochromocytoma. She was asymptomatic and normotensive. She underwent an eventful
laparoscopic left adrenalectomy preceded with taking doxazosin 1 mg daily for 3 weeks. At the age
of 29, she was found again to have elevated catecholamines while being pregnant. MRI of the
abdomen revealed a 3.3 cm right adrenal pheochromocytoma. She remained asymptomatic and
normotensive throughout the pregnancy. Elective uneventful C-Section was performed at week 38
without preoperative medical preparation. Postpartum, she remained asymptomatic while
breastfeeding. She underwent uneventful laparoscopic right adrenalectomy eight months after
delivery proceeded by taking phenoxybenzamine 10 mg twice/day for 10 days during which time
she suffered stuffy nose, fatigue, and orthostasis. Pathology interestingly revealed bifocal
pheochromocytomas in both adrenal glands.
Conclusion: We present a normotensive asymptomatic pregnant with PCC who underwent an
elective uneventful C-Section without alpha-blockade preparation with excellent maternal/fetal
outcomes. To the best of our knowledge, no similar case has been reported thus far. Preoperative
medical preparation may not be needed in asymptomatic normotensive pregnant patients with PCC
undergoing C-Section.}