Aims/Objectives This is a case presentation aiming to draw attention to the clinical suspicious of pheochromocytoma as a differential of severe hypertension in labour.

Background Pheochromocytoma in a pregnant woman is extremely rare (1:54,000 pregnancies)¹ but life threatening condition. The signs and symptoms are variable, with hypertension being one of the most prominent. Maternal and fetal mortality is around 50%. Plasma or urinary metanephrines are the tests of choice with MRI for localisation. If suspected, Caesarean section is preferred since vaginal delivery is associated with higher mortality.²

44 year-old-lady, Para 4 diagnosed with Essential Hypertension since the age of 18 presented to Labour Ward at 34 weeks for IOL due to PPROM at 26 weeks. She was on multiple anti-hypertensives prior to and during her pregnancy with controlled BP. During the second stage of labour the junior doctor observed a BP of 204/130 despite Labetalol, Hydralazin and epidural. In view of her BP, Caesarean Section was performed and a healthy baby was delivered. Post-delivery BP continued to be unstable and increased plasma adrenalin prompted the diagnosis and referral to Endocrinologist.

Conclusions

1. The case illustrates how this rare condition could present to a Junior Doctor on Labour Ward.

2. In cases when increased BP does not respond to multiple agents, pheochromocytoma is a differential diagnosis requiring prompt management to reduce associated with the condition morbidity and mortality.

References

1. Chen BF, Al-Samarrai S, Rathi M, Rajeswary J. BJOG: An International Journal of Obstetrics and Gynaecology, June 2013, 120/(54–55):1470–0328

2. Lenders JWM. European Journal of Endocrinology, February 2012, 166/2(143–150):0804–4643;1479–683X