October 28th, 2020

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Title:
Medical Management of a Paraganglioma Throughout Pregnancy: A Case Report
Authors:  Katherine L. Dengler, M.D., Kelsey J. Simpson, M.D., Payam Katebi Kashi, M.D., Ph.D., and Barton C. Staat, M.D.
 
BACKGROUND: Paragangliomas are made of neural crest cells and arise from extra-adrenal parasympathetic and sympathetic paraganglia. Catecholamine-secreting tumors are very rare in pregnancy, with fewer than 250 cases documented in the literature. Sparse literature is available regarding early diagnosis in pregnancy and conservative medical management with alpha and beta blockade with resection at time of delivery instead of surgical removal in the second trimester.

CASE: A 22-year-old, primiparous patient at 5 weeks’ gestation with known chronic hypertension was diagnosed with an incidentally found 3.7 cm retroperitoneal tumor concerning for pheochromocytoma versus paraganglioma. After evaluation and counseling, the patient desired conservative management with alpha and beta blockers throughout pregnancy. Surgical resection of the retroperitoneal mass was scheduled at the time of planned primary cesarean section at 37 weeks’ gestation. The patient underwent an uncomplicated surgery and postoperative course with excellent neonatal outcome.

CONCLUSION: This is a unique case of paraganglioma diagnosed early in pregnancy and conservatively managed with alpha antagonists and beta blockers; description of this management is sparse. Although safe surgical resection has been documented in the second trimester for catecholamine-
secreting tumors, resection was coordinated at the time of cesarean section, resulting in good outcomes for both the fetus and mother.
Keywords:  adrenal gland neoplasms, beta blockers, catecholamine-secreting tumor, catecholamines, hypertension, medical management, paraganglioma, pheochromocytoma, pregnancy, pregnancy complications
   
   
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