A reason to panic in pregnancy

An 18-year old presented at 27 weeks’ gestation with aproteinuric hypertension (178/111mmHg) with intermittent ‘panic attacks’ consisting of palpitations, left abdominal pain and perspiration. Twenty-four hour urinary catecholamine levels were >20,000nmol. Ultrasonography detected a 6.9cm x 3.6cm x 4.6cm hyperechoic structure obscuring the left adrenal. Blood pressure and tachycardia control were achieved with phenoxybenamine and labetolol, with the presumptive diagnosis of pheochromocytoma. A staging CT was undertaken prior to an elective caesarean at 37 weeks; a healthy infant was delivered. Tumor resection was perfomed a month later.