HISTORY AND ADMISSION FINDINGS: After an unremarkable course of her pregnancy a 26-year-old woman was admitted in the 32nd week because of her poor general condition with nausea, vomiting and headache. Her blood pressure was 220/140 mmHg and the pulse irregular with a rate of about 90/min. INVESTIGATIONS: The urine was markedly positive for glucose and protein, the cardiotachogram was unremarkable. DIAGNOSIS, TREATMENT AND COURSE: Antihypertensive treatment was started because pre-eclampsia was suspected. At first the patient's condition improved, but a few hours after admission an emergency section had to be performed for maternal and fetal indications, but the eutrophic male child was dead. Postoperatively the electrocardiogram and increased creatine kinase activity were suspicious of an acute myocardial infarction. Chest radiogram and echocardiography showed signs of marked ventricular dysfunction. Coronary angiography excluded coronary artery disease. The concentrations of catecholamine and its metabolites in 24-hour urine were greatly elevated above normal. Ultrasound and computed tomography demonstrated a tumour in the region of the left adrenal suggesting phaeochromocytoma, a diagnosis that was confirmed when the tumour was resected. CONCLUSIONS: Phaeochromocytoma is a rare cause of toxaemia of pregnancy and presents a high maternal and fetal risk. Its prognosis for both mother and child can be improved only if it is diagnosed and treated prenatally.
HISTORY AND ADMISSION FINDINGS: After an unremarkable course of her pregnancy a 26-year-old woman was admitted in the 32nd week because of her poor general condition with nausea, vomiting and headache. Her blood pressure was 220/140 mmHg and the pulse irregular with a rate of about 90/min. INVESTIGATIONS: The urine was markedly positive for glucose and protein, the cardiotachogram was unremarkable. DIAGNOSIS, TREATMENT AND COURSE: Antihypertensive treatment was started because pre-eclampsia was suspected. At first the patient's condition improved, but a few hours after admission an emergency section had to be performed for maternal and fetal indications, but the eutrophic male child was dead. Postoperatively the electrocardiogram and increased creatine kinase activity were suspicious of an acute myocardial infarction. Chest radiogram and echocardiography showed signs of marked ventricular dysfunction. Coronary angiography excluded coronary artery disease. The concentrations of catecholamine and its metabolites in 24-hour urine were greatly elevated above normal. Ultrasound and computed tomography demonstrated a tumour in the region of the left adrenal suggesting phaeochromocytoma, a diagnosis that was confirmed when the tumour was resected. CONCLUSIONS:Phaeochromocytoma is a rare cause of toxaemia of pregnancy and presents a high maternal and fetal risk. Its prognosis for both mother and child can be improved only if it is diagnosed and treated prenatally.