8501 Adrenal Incidentaloma In A Pregnant Woman Diagnosed With Preeclampsia
Authors: Vargas-Abonce Valerie Paola , Hernandez-Riveros Ingrid Megan , Vasquez-Vasquez Julio Alberto , Martínez-Sánchez Froylan David , Hernandez-Castillo Jose Luis , Pretel Gutiérrez Allan Ariel , Jaramillo-Salazar Thalia Gabriela , Rodriguez García Mercedes Elena , Tenorio-Aguirre Erika Karina 
Published: October 2024

Abstract
Disclosure: V.P. Vargas-Abonce: None. I.M. Hernandez-Riveros: None. J. Vasquez-Vasquez: None. F.D. Martínez-Sánchez: None. J.L. Hernandez-Castillo: None. A. Pretel Gutiérrez: None. T.G. Jaramillo-Salazar: None. M.E. Rodriguez García: None. E.K. Tenorio-Aguirre: None.
Introduction: An adrenal incidentaloma is a tumor detected on imaging conducted for reasons other than suspected adrenal disease. Whether an incidentaloma should be addressed during pregnancy has not been discussed since this condition is very uncommon. The correct diagnosis and treatment of a functional adrenal tumor has significant implications for maternal-fetal morbidity and mortality. Case Presentation: A 25-year-old woman at 37 weeks of gestation presented to the obstetric emergency department with a headache accompanied by tinnitus and dizziness. Arterial blood pressure at admission was 180/120 mmHg, and biochemical urinary analysis showed proteinuria. A diagnosis of preeclampsia was made, and an emergency cesarean section was performed due to fetal bradycardia. A live single neonate was delivered with an Apgar score of 5/9 at 1 and 5 minutes respectively. During surgery, the patient's arterial blood pressure persisted at 190/110 mmHg despite treatment with 20 mg intravenous hydralazine. At her admission to the intensive care unit, an esmolol infusion was indicated, but the patient further presented tachypnea and tachycardia. A chest Angio tomography ruled out pulmonary thromboembolism, but imaging of the abdomen revealed a right adrenal mass of 6 cm with a heterogeneous enhancement in the arterial phase. Considering the clinical evolution and the findings in tomography, a pheochromocytoma was suspected. The antihypertensive treatment was switched from labetalol to prazosin, achieving control of blood pressure and clinical improvement. The patient was discharged after five days to continue the approach of an incidentaloma. Contrast-enhanced abdominal MRI reported a 9 cm right adrenal mass with a heterogeneous center and hypointense areas suggestive of necrosis. Plasma-free metanephrine was reported at 128 pg/mL (reference value &lt;100 pg/mL) and normetanephrine at 3976 pg/mL (reference value &lt;126 pg/mL). A right adrenalectomy was scheduled. Conclusion: In the workup of an incidentaloma, suggestive characteristics of malignancy in TC, and functional evaluation guided by the patient's clinical manifestations must be addressed concurrently. In this case, the presence of an adrenal incidentaloma larger than 4 cm with &gt;10 HU in a pregnant woman diagnosed with preeclampsia who had an inadequate response to the standard treatment led to the consideration of a probable pheochromocytoma as a secondary cause of hypertension, which influenced the change of antihypertensive treatment to alpha-adrenergic blockade, followed by patient clinical improvement. Although the presence of a pheochromocytoma is much less common than preeclampsia as a cause of hypertension in pregnancy, a misdiagnosis can increase maternal morbidity and mortality by up to 15%. After adequate treatment of the obstetric emergency, the approach to incidentaloma in pregnancy is recommended.
Presentation: 6/3/2024