Case Report Minimally Invasive Adrenalectomy for Pheochromocytoma During Pregnancy David E. Pace, MD, Patrick M. Chiasson, MD, Christopher M. Schlachta, MD, Joseph Mamazza, MD, Margherita O. Cadeddu, MD, and Eric C. Poulin, MD Summary: Pheochromocytoma during pregnancy is a very rare condition; fewer than 200 cases have been reported in the literature. We present the case of a 24-year-old pregnant woman found to have a pheochromocytoma during investigation of abdomi- nal pain. This is the second reported case of laparoscopic adrenalectomy for pheo- chromocytoma detected during pregnancy. After appropriate radiologic investigation and medical management, a laparoscopic left adrenalectomy was performed at the beginning of the second trimester. There were no complications, and she was delivered of a healthy baby at term. We review the management of pheochromocytoma in pregnant patients and discuss the role of laparoscopy. Key Words: Adrenalectomy— Laparoscopic procedures—Laparoscopy—Pheochromocytoma—Pregnancy. Pheochromocytoma is a very rare condition, of which the incidence ranges from 0.5% to 0.8% at autopsy (1). Fewer than 200 cases of pheochromocytoma in preg- nancy have been published in the literature. Its presen- tation is similar to that in nonpregnancy, with findings of hypertension, headaches, sweating, and palpitations, and is often difficult to differentiate from pregnancy-induced hypertension. High fetal mortality (26–54%) and high maternal mortality (17–48%) have been reported in as- sociation with unrecognized pheochromocytoma (2,3). These mortality figures are markedly improved with early detection, adrenergic blockade, and surgical re- moval of the affected adrenal gland (3,4). Recent ad- vances in laparoscopic surgery have allowed for success- ful removal of pheochromocytomas with a more rapid and comfortable recovery and a shorter hospital stay (5). CASE DESCRIPTION A 24-year-old woman (gravida 1/para 0) with a history of right-upper-quadrant pain sought treatment at our fa- cility. She also had had intermittent episodes of head- aches, sweating, and palpitations over the preceding year. Abdominal ultrasonography revealed gallstones as well as a left adrenal mass, 6 cm in maximum diameter. A 24-hour urinary collection revealed elevated levels of catecholamines (1,049 nmol/d; normal, <600 nmol/d), urinary VMA (60 mol/d; normal, 6–36 mol/d), and urinary metanephrines (25.6 mol/d; normal, <5.5 mol/d). Before computed tomography was performed, a serum –human chorionic gonadotropin test confirmed the pregnancy. Thus, the computed tomography was can- celed, and magnetic resonance imaging was done, which further defined the 6-cm left adrenal mass. The patient had undergone an uncomplicated tonsil- lectomy 1 year previously. She had a history of asthma, which was controlled with salbutamol taken as needed. She had no allergies. The family medical history was unremarkable. Initial examination revealed a pulse rate of 72. Her blood pressure was 120/80 mm Hg, with no postural drop. Heart sounds were normal, and there was a grade 2 systolic ejection murmur. Otherwise, physical ex- Received June 5, 2001; revision received December 6, 2001;ac- cepted December 12, 2001. From The Center for Minimally Invasive Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada Address correspondence and reprint requests to: Dr. E. C. Poulin, Surgeon-in-Chief, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. Address electronic mail to: eric.poulin@ utoronto.ca Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Vol. 12, No. 2, pp. 122–125 © 2002 Lippincott Williams & Wilkins, Inc., Philadelphia 122