產後持續性高血壓揭露嗜鉻細胞瘤：超越子癲前症的診斷挑戰

楊宏祥¹、賴宗豪^1,2、許軒豪^1,2*

¹臺北市立萬芳醫院泌尿科－委託財團法人臺北醫學大學辦理

²臺北醫學大學泌尿學科

Persistent Hypertension after Delivery Revealing a Pheochromocytoma: A Diagnostic Challenge Beyond preeclampsia

Hung-Hsiang Yang¹, Benjamin Chung-Howe Lai^1,2, Syuan-Hao Syu^1,2*

¹Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Background: Postpartum hypertension affects up to 20% of women within six weeks after delivery. While most cases represent persistence of preeclampsia or transient physiological changes, secondary causes must be considered when blood pressure remains severe or treatment-resistant. Pheochromocytoma, although rare, can present during or after pregnancy and mimic preeclampsia, leading to delayed diagnosis and potentially fatal outcomes.

Case Presentation: We report a 39-year-old woman with a history of preeclampsia with severe features who developed persistent postpartum hypertension unresponsive to multiple antihypertensive agents. Her medical history included hyperthyroidism, left parathyroid adenoma, pituitary macroadenoma, and autoimmune disease. Two years after delivery, she experienced paroxysmal hypertension up to 230 mmHg with chest discomfort. Biochemical evaluation showed markedly elevated urinary catecholamines and vanillylmandelic acid. Abdominal computed tomography revealed a 3.8 cm right adrenal mass consistent with pheochromocytoma. Following α-adrenergic blockade with doxazosin and robotic-assisted laparoscopic adrenalectomy, histopathology confirmed pheochromocytoma, and her blood pressure normalized postoperatively.

Discussion: This case illustrates the diagnostic challenge of distinguishing persistent postpartum hypertension due to residual preeclampsia from secondary endocrine causes such as pheochromocytoma. Overlapping clinical features frequently delay recognition, as the classic triad of headache, palpitations, and diaphoresis occurs in only a minority of patients and is even less reliable during pregnancy and the postpartum period. Langton et al. identified factors associated with an antepartum diagnosis of pheochromocytoma or paraganglioma—such as a known prior diagnosis, pathogenic mutation, adrenal mass, hypertension at admission, and diaphoresis—whereas delayed recognition was linked to an initial diagnosis of preeclampsia, elective obstetric admission, acute symptom onset, and maternal tachycardia. In our patient, the coexistence of pituitary macroadenoma and parathyroid adenoma suggested a possible multiple endocrine neoplasia (MEN)-like phenotype, underscoring the importance of recognizing endocrine clustering as a diagnostic clue. Incorporating endocrine pattern recognition into the evaluation of postpartum hypertension may facilitate earlier identification of secondary causes and prevent potentially fatal outcomes.

Conclusion: Persistent or severe postpartum hypertension should prompt evaluation for secondary causes. Pheochromocytoma, though rare, must be considered when blood pressure is refractory or atypical. Early recognition and surgical management are essential for a curative outcome and prevention of maternal morbidity.