Paraganglioma khởi phát trong thai kì: Báo cáo ca lâm sàng=Paraganglioma onset during pregnancy: A case report

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Tác giả: Quốc Hội Huỳnh, Thế Ngọc Phùng, Lê Duy Anh Trần, Tuấn Khoa Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.376-383

Bộ sưu tập: Metadata

ID: 243561

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Pheochromocytoma and paraganglioma are rare catecholamine-secreting neuroendocrine tumors. When first appeared during pregnancy, the diagnosis is difficult and can be missed, leading to poor outcomes for both mother and baby. We report a case of a 25-year-old primiparous pregnant woman with no personal or familial hypertensive history who developed severe hypertension in the second trimester, characterized by uncontrolled and fluctuating blood pressure with alternating periods of hypotension and severe hypertension. Due to uncontrolled blood pressure, induction of delivery was performed at about 28 weeks of gestation but failed, and the patient was then transferred to an emergency cesarean section. Fortunately, both mother and child were safe (28- week-old boy, birth weight: 1.150g, Apgar 1 min = 4, 5 min = 6). During the period of 5 months after delivery, the patient experienced periodically episodes of hypertension associated with nausea, vomiting and heavy sudation, paraganglioma was diagnosed on CT and open surgery was performed to remove the tumor after careful preoperative preparation. Pathology results confirmed the diagnosis of paraganglioma. After surgery, the patient was stable, blood pressure was normal without a need for antihypertensive medication. Genetic testing results showed a mutation in the MEN1 gene.Pheochromocytoma và paraganglioma là những u nội tiết thần kinh tiết catecholamines hiếm gặp. Khi bệnh khởi phát trong thai kì, việc chẩn đoán gặp nhiều khó khăn và có thể bị bỏ sót dẫn đến kết cục xấu cho cả mẹ và con. Chúng tôi báo cáo một trường hợp thai phụ 25 tuổi, mang thai lần đầu, tiền căn bản thân và gia đình không ai tăng huyết áp, khởi phát tăng huyết áp nặng ở khoảng tam cá nguyệt 2, huyết áp khó kiểm soát và dao động nhiều, với những cơn tụt huyết áp và huyết áp tăng cao. Do huyết áp khó kiểm soát, bệnh nhân được khởi phát chuyển dạ sinh thường khi thai khoảng 28 tuần nhưng thất bại, sau đó chuyển mổ lấy thai cấp cứu. Rất may mắn, cả mẹ và con đều an toàn (Bé trai, 28 tuần tuổi, cân nặng lúc sinh: 1.150g, Apgar 1 phút = 4
5 phút = 6). Khoảng 5 tháng sau sinh, bệnh nhân xuất hiện nhiều lần những cơn tăng huyết áp kèm buồn ói, ói và vã mồ hôi nhiều
paraganglioma được chẩn đoán dựa trên hình ảnh CT scan và tiến hành mổ mở cắt u sau khi đã chuẩn bị tiền phẫu cẩn thận. Kết quả giải phẫu bệnh phù hợp chẩn đoán paraganglioma. Sau mổ, bệnh nhân ổn định, huyết áp bình thường mà không cần dùng thuốc hạ áp. Kết quả xét nghiệm gen ghi nhận đột biến gen MEN1.

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