P171 Three cases of secondary hypertension with adrenal diseases in pregnancy

Pheochromocytoma is a catecholamine-secreting adrenal tumor and also a rare cause of secondary hypertension in pregnancy. Its low prevalence, nonspecific clinical presentation, and symptoms similar to preeclampsia generate a diagnostic challenge during pregnancy. A 23-year-old hypertensive pregnant woman at 36th gestational week of her first pregnancy was admitted with severe hypertension (210/150 mmHg), headache and proteinuria that made us presume the case as severe preeclampsia. In spite of starting with maximum doses of antihypertensive medications like IV labetolol,and oral nifedipine, loading dose of an anticonvulsant drug, and IV magnesium sulphate, her symptoms persisted. Keeping in view the risks involved to mother and fetus, we delivered the baby by emergency cesarean section. In the postoperative period, along with severe uncontrolled hypertension, she developed tremors, palpitation, and sweating that all led us to further diagnostic workup for secondary causes of hypertension. Eventually, a diagnosis of pheochromocytoma was confirmed by abdominopelvic contrast- enhanced computed tomography and by increased 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid levels. Subsequently, adrenal suppression was achieved by a multidisciplinary approach, and then she underwent laparoscopic adrenalectomy. This case highlights the importance of maintaining a high index of suspicion and multidisciplinary approach while investigating secondary causes of hypertension in young women, thereby differentiating it from preeclampsia.

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A case report on IgA nephropathy in pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193574 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3402

Author(s):

Nupur Anand ◽

A. V. Gokhale ◽

Shonali Agarwal

Keyword(s):

Renal Function ◽

Iga Nephropathy ◽

Intrauterine Growth Retardation ◽

Secondary Hypertension ◽

Successful Outcome ◽

Primary Glomerulonephritis ◽

Intrauterine Growth ◽

Increased Risk ◽

Primary Glomerular Disease ◽

In Pregnancy

IgA Nephropathy is a primary glomerular disease leading cause of primary glomerulonephritis and one of the important leading cause of secondary hypertension. Pregnancy causes complex pathological changes in patients with IgA nephropathy affecting the renal function leading to secondary hypertension which in turn affects the prognosis of these patients. The association between chronic kidney disease and increased risk of adverse maternal and fetal outcomes which includes pre-eclampsia, accelerated decline in renal function, intrauterine growth retardation, preterm delivery and fetal death, is well recognised. Management of patients with IgA Nephropathy in pregnancy is challenging and thus authors are discussing here a case with successful outcome. Our patient was a known case of IgA Nephropathy and landed up with complications during pregnancy which was manged successfully.

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Chronic essential and secondary hypertension in pregnancy

Best Practice & Research Clinical Obstetrics & Gynaecology ◽

10.1053/beog.1999.0010 ◽

1999 ◽

Vol 13 (1) ◽

pp. 115-130 ◽

Cited By ~ 6

Author(s):

Eileen D.M. Gallery

Keyword(s):

Secondary Hypertension ◽

Hypertension In Pregnancy ◽

In Pregnancy

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Secondary hypertension in pregnancy

Hypertension in Pregnancy ◽

10.1017/cbo9780511902529.009 ◽

2011 ◽

pp. 97-108

Author(s):

Fergus P. McCarthy ◽

Alexander Heazell ◽

Errol R. Norwitz ◽

Louise C. Kenny ◽

Philip N. Baker

Keyword(s):

Secondary Hypertension ◽

Hypertension In Pregnancy ◽

In Pregnancy

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Curative resection of an aldosteronoma causing primary aldosteronism in the second trimester of pregnancy

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0043 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Skand Shekhar ◽

Rasha Haykal ◽

Crystal Kamilaris ◽

Constantine A Stratakis ◽

Fady Hannah-Shmouni

Keyword(s):

Primary Aldosteronism ◽

Secondary Hypertension ◽

Uncontrolled Hypertension ◽

List Type ◽

Second Trimester ◽

Unilateral Adrenalectomy ◽

Fetal Complications ◽

Common Etiology ◽

History Of ◽

In Pregnancy

Summary A 29-year-old primigravida woman with a known history of primary aldosteronism due to a right aldosteronoma presented with uncontrolled hypertension at 5 weeks of estimated gestation of a spontaneous pregnancy. Her hypertension was inadequately controlled with pharmacotherapy which lead to the consideration of surgical management for her primary aldosteronism. She underwent curative right unilateral adrenalectomy at 19 weeks of estimated gestational age. The procedure was uncomplicated, and her blood pressure normalized post-operatively. She did, however, have a preterm delivery by cesarean section due to intrauterine growth retardation with good neonatal outcome. She is normotensive to date. Learning points: Primary aldosteronism is the most common etiology of secondary hypertension with an estimated prevalence of 5–10% in the hypertensive population. It is important to recognize the subtypes of primary aldosteronism given that certain forms can be treated surgically. Hypertension in pregnancy is associated with significantly higher maternal and fetal complications. Data regarding the treatment of primary aldosteronism in pregnancy are limited. Adrenalectomy can be considered during the second trimester of pregnancy if medical therapy fails to adequately control hypertension from primary aldosteronism.

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