Diagnosis and Management of Pheochromocytoma in Pregnancy: A Multidisciplinary Approach to Treatment and Outcomes at Mbarara Regional Referral Hospital: A Case Report

Abstract

Introduction: Pheochromocytoma in pregnancy is extremely rare but can be life-threatening for both mother and fetus. Its clinical manifestations often mimic common obstetric complications, such as preeclampsia, resulting in delayed or missed diagnosis with potentially catastrophic consequences. Prompt recognition and careful management are critical to improving maternal and neonatal outcomes. Case Presentation: We report a 27-year-old Black African multiparous refugee woman at 26 weeks of gestation who presented with palpitations, shortness of breath, headaches, and markedly fluctuating blood pressure. Ultrasonography revealed a large right adrenal mass, and 24-hour urinary metanephrines confirmed catecholamine excess. Despite antihypertensive therapy, she continued to experience alternating hypertensive and hypotensive crises, necessitating an emergency cesarean delivery at 31 weeks of gestation. A live preterm neonate weighing 1.8 kg was delivered in good condition. Ten weeks postpartum, she underwent laparoscopic adrenalectomy. Histopathological examination and immunohistochemistry evaluation confirmed the diagnosis of pheochromocytoma. Conclusion: This case highlights the diagnostic challenge of pheochromocytoma in pregnancy, which can masquerade as preeclampsia and other hypertensive disorders. It underscores the importance of considering pheochromocytoma in the differential diagnosis of labile blood pressure during pregnancy. Multidisciplinary coordination, vigilant hemodynamic stabilization, and timely postpartum surgery can achieve excellent maternal and neonatal outcomes.