Taiwanese Journal of Obstetrics & Gynecology (Dec 2004)
Early-Onset Oligohydramnios Complicated with Hypertension, Hyperthyroidism and Coexisting Elevated Urine Vanillylmandelic Acid of Unknown Origin, Mimicking a Pheochromocytoma
Abstract
Objective: Oligohydramnios is associated with increased perinatal morbidity and mortality. It may be due to a variety of conditions, including rupture of membranes, fetal urinary tract abnormalities such as megacystis caused by posterior urethral valve, and prerenal abnormalities involving uteroplacental insufficiency possibly due to hypertension, and hyperthyroidism. Hyperthyroidism affects 0.2% of pregnant women and is associated with a higher risk of pre-eclampsia. We report a case that presented initially with early-onset oligohydramnios and later developed a hypertensive crisis that was associated with undiagnosed hyperthyroidism. A pheochromocytoma was also suspected because of increased 24-hour urine vanillylmandelic acid excretion but was dismissed after imaging studies. Case Report: A 36-year-old woman, gravida 2, para 1, was referred to our hospital because of a high-risk result on maternal serum Down syndrome screening (risk, 1:40) at a gestational age of 22 weeks. A hypertensive crisis developed and her condition deteriorated rapidly, so the pregnancy was terminated. Subsequent investigation revealed previously undiagnosed hyperthyroidism and increased urine 24-hour vanillylmandelic acid excretion. Magnetic resonance imaging failed to reveal any signs of a pheochromocytoma or an ectopic adrenal gland. Hypertension and hyperthyroidism were controlled medically 6 weeks postpartum. Urine catecholamine levels returned to normal 3 days postpartum. Conclusion: A combination of hypertension, oligohydramnios and hyperthyroidism is rare. An elevated 24- hour urine vanillylmandelic acid of unknown origin is a previously unreported finding, to the best of our knowledge, associated with hyperthyroidism and pregnancy-induced hypertension.
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