Pregnancy and phaeochromocytoma/paraganglioma: clinical clues affecting diagnosis and outcome – a systematic review

Abstract

BackgroundPhaeochromocytoma and paraganglioma (PPGL) in pregnancy, if not diagnosed antepartum, pose a high risk for mother and child.ObjectiveTo examine the clinical clues of antepartum and postpartum/postmortem diagnosis of PPGL.Search strategyCase reports on PPGL in pregnancy published between 1 January 1988 and 30 June 2019 in English, German, Dutch or French.Selection criteriaCase reports containing a predefined minimum of clinical data on PPGL and pregnancy.Data collection and analysisTwo authors independently performed data extraction and assessed data quality. We calculated odds ratios (OR) (with 95% confidence intervals) and used uni‐ and multivariable logistic regression analysis.Main resultsMaternal and fetal/neonatal mortalities were 9.0% (18/200) and 14.2% (29/204), respectively. Maternal mortality was 42‐fold higher with PPGL diagnosed postpartum/postmortem (17/58; 29.3%) than antepartum (1/142; 0.7%) (adjusted OR 45.9, 95% CI 5.67–370, P = 0.0003). Offspring mortality was 2.6‐fold higher with PPGL diagnosed postpartum/postmortem than antepartum (OR 3.1, 95% CI 1.38–6.91, P = 0.0044). Hypertension at admission (OR 2.29, 95% CI 1.12–4.68, P = 0.022), sweating (OR 3.14, 95% CI 1.29–7.63, P = 0.014) and a history of PPGL, a known PPGL‐associated gene mutation or adrenal mass (OR 8.87, 95% CI 1.89–41.64, P = 0.0056) were independent factors of antepartum diagnosis. Acute onset of symptoms (OR 8.49, 95% CI 3.52–20.5, P < 0.0001), initial diagnosis of pre‐eclampsia (OR 6.34, 95% CI 2.60–15.5, P < 0.0001), admission for obstetric care (OR 10.71, 95% CI 2.70–42.45, P = 0.0007) and maternal tachycardia (OR 2.72, 95% CI 1.26–5.85, P = 0.011) were independent factors of postpartum diagnosis.ConclusionSeveral clinical clues can assist clinicians in considering an antenatal diagnosis of PPGL in pregnancy, thus potentially improving outcome.Tweetable abstractSystematic review of 204 pregnant patients with phaeochromocytoma identified clinical clues for a timely antepartum diagnosis.