Pheochromocytoma presents serious risks to both the mother and fetus, largely due to the excessive release of catecholamines, which can trigger hypertensive crises and other severe complications.
Life-Threatening Hypertensive Crises
Catecholamine surges can cause dangerously high blood pressure, either spontaneously or triggered by factors like fetal movements, uterine contractions, pressure of the enlarging uterus on the tumor (especially when supine), vaginal delivery, surgical interventions, or drugs such as metoclopramide, glucocorticoids, and beta-blockers given without alpha-blockade. These hypertensive episodes can result in stroke, heart failure, or organ damage in the mother. For the fetus, compromised uteroplacental blood flow due to vasoconstriction can lead to intrauterine hypoxia, growth restriction, or fetal death.
Increased Risk of Preterm Labor, Placental Abruption, and Fetal Death
Pheochromocytoma complicates pregnancy by causing uteroplacental vasoconstriction, which restricts blood flow to the placenta. This can increase the risk of placental abruption, where the placenta prematurely detaches from the uterine wall, leading to life-threatening hemorrhage for both mother and baby. Inadequate blood flow can also lead to intrauterine growth restriction (IUGR) and may trigger preterm labor. Sustained hypertension or hypertensive crises can result in fetal death, either from hypoxia or placental abruption. If untreated, fetal mortality in cases of pheochromocytoma can be as high as 50%, though early diagnosis and management can reduce this to approximately 15%.
Maternal Complications
Stroke, Heart Failure, Arrhythmias: The most immediate risk to the mother is the development of a hypertensive crisis, which can lead to stroke, myocardial infarction, or heart failure. Excessive catecholamine stimulation of the heart can also result in arrhythmias, such as atrial fibrillation or ventricular tachycardia, which further compromise cardiac function and oxygen delivery to vital organs.
Other maternal risks include pulmonary edema, which may arise from heart failure or catecholamine-induced capillary leakage, as well as acute coronary syndrome, aortic dissection, and peripartum cardiomyopathy. These complications can mimic more common pregnancy-related conditions, but immediate intervention is critical due to the underlying pheochromocytoma.
