Pheochromocytoma presenting as acute non-ST elevation myocardial infarction following elective hysterectomy.

INTRODUCTION: Studies have shown patients with pheochromocytoma have a 14-fold higher rate of cardiovascular events than patients with essential hypertension. CASE PRESENTATION: A 47-year-old female was found to have elevated troponins and marked ST depression following elective hysterectomy. The patient underwent cardiac catheterization, and labile blood pressures with a narrow-complex tachycardia were noted during the procedure. No evidence of coronary artery disease or wall motion abnormality was found. After catheterization, the patient complained of abdominal pain with difficulty passing gas. CT abdomen/pelvis revealed a 4.3 x 5 cm left adrenal mass. Plasma metanephrines and 24-hour urine catecholamines suggested pheochromocytoma. She underwent left total adrenalectomy, and pathology confirmed pheochromocytoma. At 3-month follow-up, she was asymptomatic and required only one agent for blood pressure control. DISCUSSION: Suspecting pheochromocytoma in patients with an unexpected myocardialevent and labile hypertension can lead to prompt diagnosis and appropriate preoperative management as well as avoidance of unnecessary procedures.

Thyroid disease in pregnancy: (Women's Health Series).

Pregnancy is a state of many hormonal changes that can make interpretation of thyroid function tests difficult. Measuring trimester-specific reference values of thyrotropin and free thyroxine is recommended. Because overt maternal hypothyroidism negatively affects the fetus, timely recognition and treatment are important. Women taking levothyroxine prepregnancy require a ≤50% dose increase during pregnancy. Hyperthyroidism can result from excessive human chorionic gonadotropin or Graves disease. Radioactive scanning should be avoided during pregnancy. Antithyroidal drug therapy should consist of propylthiouracil during the first trimester and methimazole thereafter. If indicated, beta blockers can be administered under obstetrical supervision. Iodine deficiency is a known goitrogen and stimulus for thyroid nodular growth. Thyroid nodules may enlarge, but the incidence of thyroid cancer is not increased during pregnancy. Suspicious nodules should be biopsied and, if necessary, removed during the second trimester; otherwise, follow-up can safely be conducted postpartum. Thyroid-stimulating hormone suppression for any preexisting thyroid cancer or suspicious nodules should achieve free or total T4 in the upper normal range for pregnancy. Postpartum thyroiditis occurs more frequently in antithyroid peroxidase-positive women, who should be screened by measuring serum thyrotropin at 6 to 12 weeks' gestation and at 3 and 6 months postpartum.