Lyman David J
Department of Family Medicine, University of Tennessee, Jackson, USA.
J Am Board Fam Pract. 2002 Mar-Apr;15(2):153-8.
Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality.
A patient with severe hypertension, postpartum pulmonary edema, and a recognized pheochromocytoma is described.
Abdominal palpation after vaginal childbirth reproduced the diagnostic triad of hypertension, headaches, and palpitations. Magnetic resonance imaging established the correct diagnosis before biochemical confirmation of excess catecholamine production. The patient responded to alpha-adrenergic receptor blockade with control of her severe hypertension and clearing of pulmonary edema. The best time to diagnose a pheochromocytoma is before delivery because vaginal childbirth stimulates the release of lethal amounts of catecholamines.
The physician who delivers babies must distinguish between labile hypertension and paroxysmal hypertension. Most experts believe that a spontaneous vaginal delivery is contraindicated when the patient has a pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma is unusual. The profound pressor response elicited by palpation of the postpartum abdomen, the failure of medications usually effective in the treatment of a hypertensive crisis, and the use of magnetic resonance imaging to confirm a functioning adrenal adenoma are the features unique to this case.
高血压是妊娠最常见的医学并发症。妊娠期嗜铬细胞瘤罕见，若未被识别，可导致严重的围产期发病和死亡。
描述了一名患有严重高血压、产后肺水肿且已确诊嗜铬细胞瘤的患者。
阴道分娩后腹部触诊再现了高血压、头痛和心悸的诊断三联征。在生化证实儿茶酚胺分泌过多之前，磁共振成像已确立了正确诊断。患者对α-肾上腺素能受体阻滞剂有反应，严重高血压得到控制，肺水肿消退。诊断嗜铬细胞瘤的最佳时机是在分娩前，因为阴道分娩会刺激释放致命量的儿茶酚胺。
接生的医生必须区分不稳定高血压和阵发性高血压。大多数专家认为，患者患有嗜铬细胞瘤时，禁忌自然阴道分娩。与嗜铬细胞瘤相关的产后肺水肿并不常见。产后腹部触诊引起的强烈升压反应、通常对治疗高血压危象有效的药物治疗无效以及使用磁共振成像来证实功能性肾上腺腺瘤是该病例独有的特征。
