SAT-496 Cystic Pheochromocytoma in a Pregnant Female

Abstract Disclosure: M. Paravastu: None. D. Kaul: None. K. Mitrollari: None. R. Patel: None. Background: Pheochromocytoma during pregnancy is a rare and potentially life-threatening condition to both mother and fetus. It is a rare presentation with an incidence of approximately 0.002% of all pregnancies. Symptoms of pheochromocytoma in pregnancy can be non-specific and may overlap with pre-eclampsia or pregnancy related hypertension, making it a diagnostic challenge. We report a rare case of a pregnant patient who presented with migraines, anxiety and epigastric pain and was diagnosed with a cystic pheochromocytoma. Clinical Case: A 29 y/o pregnant female 25w4d with no PMH presented to the hospital for symptoms of episodic migraines, panic attacks and epigastric pain for 2 weeks. On admission, she was found to be hypertensive and was treated with IV labetalol. Abdominal ultrasound revealed a 5.8 cm cystic structure potentially arising from the left adrenal gland. A follow up MRI abdomen without contrast confirmed the presence of a 5.8 x 6.0 x 6.1 cm thick-walled T2 hyperintense structure centered in the left suprarenal space. Laboratory tests were notable for elevated plasma metanephrines 3.09 nmol/L [0-0.49 nmol/L] and normetanephrine 11.73 nmol/L [0-0.89 nmol/L]. The rest of the labs returned within normal limits including random serum cortisol 19.4 mcg/dL [3.4-22.2 mcg/dL], DHEA-S 15.1 mcg/dL [8-391 mcg/dL], Renin 1 ng/mL/hr [0.5-4 ng/mL/hr] and Aldosterone 9.9 ng/dL [4-31 ng/dl]. She was initiated on alpha blockade with doxazosin and nifedipine for additional blood pressure control. Initially, the plan was to deliver the baby at 37 weeks with left adrenalectomy scheduled for post-partum. However, due to preeclampsia with severe features, she underwent urgent C-section at 27w5d. She was discharged home post c-section on Doxazosin 8mg twice daily. At 4 weeks post-partum, she underwent laparoscopic left adrenalectomy without complications. Surgical pathology returned positive for pheochromocytoma. Her symptoms resolved post-adrenalectomy and she no longer required antihypertensive medications. Discussion: Cystic pheochromocytomas are a rare variant of adrenal pheochromocytomas, and they present a diagnostic challenge as they can resemble a benign adrenal cyst on imaging. Additionally, spontaneous rupture of cystic pheochromocytomas have been reported in literature, which can be life threatening. Open adrenalectomy is often recommended to avoid tumor rupture; however, our patient underwent a successful laparoscopic adrenalectomy. Pheochromocytomas in pregnancy can also present another diagnostic challenge as symptoms are often non-specific and attributed to pre-eclampsia or pregnancy related hypertension. Due to high maternal and fetal mortality risk nearing 50%, it is crucial for clinicians to be aware of such entity to recognize and treat promptly. Presentation: Saturday, July 12, 2025