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首页> 外文期刊>Canadian journal of anesthesia: Journal canadien d'anesthesie >Pheochromocytoma and pregnancy: a case report and review of anesthetic management: (Pheochromocytome et grossesse. Expose d'un cas et revue de la demarche anesthesique).
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Pheochromocytoma and pregnancy: a case report and review of anesthetic management: (Pheochromocytome et grossesse. Expose d'un cas et revue de la demarche anesthesique).

机译：嗜铬细胞瘤和妊娠：一例病例报告和麻醉治疗回顾：（嗜铬细胞瘤和妊娠。一例病例和麻醉过程回顾）。

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PURPOSE: To describe a patient diagnosed with pheochromocytoma in the third trimester of pregnancy and discuss the perioperative and anesthetic management. Clinical features: A 32-yr-old previously healthy woman (gravida 4, para 2) presented to our tertiary care obstetrical hospital at 34 weeks five days gestation with a history of labile blood pressure and severe hypertension. A week prior to admission she began having episodes of severe headache, dizziness, sweating and nausea. On a routine obstetric visit she was noted to be severely hypertensive with a blood pressure of 200/120 mmHg. Biochemical investigations confirmed the diagnosis of pheochromocytoma and magnetic resonance imaging demonstrated a 3 cm x 3 cm right adrenal mass. The patient was invasively monitored in the intensive care unit and treated with alpha- followed by beta-blockade with phenoxybenzamine and metoprolol. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. An uncomplicated laparoscopic adrenalectomy was performed following a period of recovery after an uneventful elective Cesarean delivery. CONCLUSIONS: The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, avoidance of a hypertensive crisis during delivery and definitive surgical treatment. Timing of surgical resection will depend on the gestational age at which diagnosis is made. Cesarean section is the preferred mode of delivery when the tumour is still present. This case illustrates that with antenatal diagnosis, advanced methods of tumour localization, adequate preoperative adrenergic blockade and team planning, pheochromocytoma in pregnancy can be treated successfully.
机译：目的：描述一名在妊娠晚期诊断为嗜铬细胞瘤的患者，并讨论围手术期和麻醉处理。临床特征：一名32岁以前健康的妇女（妊娠4，第2段）在妊娠5天时第34周出现在我们的三级产科医院，有高血压和严重高血压的病史。入院前一周，她开始出现严重的头痛，头晕，出汗和恶心的发作。在常规的产科检查中，她被发现严重高血压，血压为200/120 mmHg。生化研究证实了嗜铬细胞瘤的诊断，磁共振成像显示右侧肾上腺肿块3 cm x 3 cm。在重症监护室对患者进行了侵入性监测，先用α-治疗，然后用苯氧基苯甲胺和美托洛尔进行β-阻断治疗。组织了一次涉及内分泌学，麻醉学，普外科和产科的多学科会议，以确定最合适的患者治疗方法。在顺利行择期剖宫产后恢复一段时间后，进行了简单的腹腔镜肾上腺切除术。结论：妊娠期嗜铬细胞瘤的治疗的主要目标是早期诊断，避免分娩时发生高血压危机和进行明确的手术治疗。手术切除的时间取决于诊断的胎龄。当肿瘤仍然存在时，剖宫产是首选的分娩方式。该病例说明，通过产前诊断，先进的肿瘤定位方法，术前充分的肾上腺素能阻滞和团队计划，可以成功治疗孕妇的嗜铬细胞瘤。

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