Impact of maternal pheochromocytoma on the fetus and neonate

Abstract

Pheochromocytoma during pregnancy is rare but potentially harmful to the mother and fetus. Fetal risks are mainly determined by the vasoconstrictive effects of maternal catecholamine on uteroplacental circulation, because the fetus is protected from the direct effects of high catecholamine levels at the placental interface. Uteroplacental insufficiency may lead to spontaneous abortion, fetal growth restriction, premature delivery, and fetal hypoxia, followed by fetal distress and/or birth asphyxia. Adrenalectomy is recommended during the second trimester. When a diagnosis is made during the late second or third trimester, appropriate medical treatment until term and planned delivery with concurrent or delayed adrenalectomy can result in good fetal outcomes. Moreover, when adrenalectomy is planned after delivery, there is concern regarding the potential of antihypertensive drugs to be transferred to breast milk. It is generally known that early detection and proper treatment of pheochromocytoma during pregnancy decrease maternal and fetal mortality. However, in recent case series, antenatal maternal pheochromocytoma diagnosis did not significantly decrease the risk of fetal and neonatal mortality and morbidity, contrary to the maternal death and complication rates. Although intrauterine ischemia and hypoxia due to uteroplacental insufficiency can affect the long-term outcomes of neonates, no systematic studies have been performed.

摘要

妊娠合并嗜铬细胞瘤很少见, 但可能对母亲及胎儿有害。胎儿风险主要取决于母体儿茶酚胺对子宫胎盘循环的血管收缩作用, 因为胎盘屏障的保护作用, 胎儿并不直接受到高儿茶酚胺水平的影响。子宫胎盘功能不全可导致自然流产, 胎儿生长受限, 早产和胎儿缺氧, 其次是胎儿窘迫和/或出生时窒息。建议于妊娠中期行肾上腺切除术。当在妊娠中晚期或晚期进行诊断时, 持续至分娩的适当的药物治疗和计划分娩同时或延迟行肾上腺切除术可以产生较好的胎儿预后。此外, 计划在分娩后行肾上腺切除术时, 抗高血压药物分泌至母乳的可能性是值得担忧的。众所周知, 妊娠期间嗜铬细胞瘤的早期诊断和适当治疗会降低母胎死亡率。然而, 在最近的一系列病例中, 产前母体嗜铬细胞瘤的诊断并没有显著降低胎儿和新生儿死亡率和发病率的风险, 与产妇死亡率和并发症发生率相反。虽然子宫胎盘功能不全导致的宫内缺血和缺氧会影响新生儿的长期预后, 但目前尚未进行系统性研究。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Pheochromocytoma
• pregnancy
• fetus
• neonate
• antihypertensive

Disclosure statement

The author reports no conflict of interest. The author received no specific funding for this work.