She had a known history of poorly controlled hypertension
since 2003, but no clinical symptoms suspicious for a pheo. Her second pregnancy ended in a second
trimester miscarriage secondary to hypertensive emergency.
During her third pregnancy, her physicians began to suspect
a secondary cause of her long-standing, poorly controlled hypertension. She had
urinary metanephrines (metadrenaline) drawn that were > 15 ULN . An MRI demonstrated a 9 x 9 x 10 cm left adrenal mass (see below) Her pheo
diagnosis was made at at 20 wks EGA. She had a surgical consultation, but her
mass was deemed inoperable given the degree of vascular encasement by the mass.
Termination of the pregnancy was discussed, but she and her husband decided to
continue the pregnancy.
She monitors her blood pressures (BPs) at home, taking
measurements 4-5 times daily. A review of her ambulatory blood pressure showed that
all of her BP readings were between 110s-120s/70s-80s on a regimen of Doxazosin
12mg qdaily, Atenolol 25mg qdaily, and Nifedipine 30mg qdaily.
IMAGING
Left adrenal mass 9 x9 x10 cm compressing the kidney and
pancreas, and encasing the celiac trunk.
TREATMENT PLAN
The current treatment plan is to continue her current
regimen and admit her to the high risk maternity ward at week 32 (next week)
and to induce labor at week 33 or 34.
Check back next week and I will update you on her clinical
course.
No comments:
Post a Comment