Adrenal Tumours in Pregnancy
Key points
- Adrenal tumours secrete excessive hormones which adversely affect maternal and fetal health.
- Adrenal tumours are managed with specific drugs or surgery, but it is not known how these affect the mother, the fetus or the neonate.
- This study will investigate the current incidence of rare adrenal tumours including Phaeochromocytomas, those associated with Conn's Syndrome and Cushing's Syndrome. It will describe their current management and the associated outcomes for women and their infants and develop guidelines for their optimal management.
Surveillance Period
March 2011-February 2013
Background
Tumours of the adrenal glands are very rare[1] and information in the medical literature on the incidence, their management and maternal, fetal and neonatal outcomes is limited.
Phaeochromocytomas, tumours associated with Conn's Syndrome, andadrenal or pituitary tumours linked to Cushing's Syndrome produce excess steroid hormones which are associated with major pregnancy complications[2][3], including major maternal and fetal morbidity[4] and mortality[5][6]. Adrenal tumours are linked to higher rates of hypertension[1], diabetes[4] and pre-eclampsia, as well as fetal death, intrauterine growth restriction, fetal hypoxia[7], fetal distress[1][8], spontaneous abortion, stillbirth and prematurity[4]. Currently, there are no data on the incidence of adrenal tumours in pregnancy in the UK and the associated maternal, fetal and neonatal morbidity and mortality.
In addition, there are few guidelines on the appropriate pharmacological or surgical management of these tumours. Therefore, this study will examine the effects of the drugs used to treat these in relation to maternal or fetal and neonatal complications and whether the timing of the surgery to remove the tumours is important. This will allow for development of guidelines on the management of adrenal tumours in pregnancy with the ultimate aim of improving maternal and infant outcomes.
Objectives
- To use the UK Obstetric Surveillance System to describe the incidence, management and outcomes of adrenal tumours in pregnancy in the UK.
- To use this information to develop guidelines for their optimal management.
Research questions
- What is the current incidence of adrenal tumours in pregnancy in the UK?
- What are the outcomes for women and their babies?
- How is the condition managed in the UK?
- What is the role of the timing of surgery to remove the tumours and what are the complications compared to non-pregnant women in the UK?
Case definition
Any pregnant women in the UK with a functioning adrenal neuroendocrine tumour, including women diagnosed pre-pregnancy who have not undergone surgery to remove the tumour.
INCLUDED
Phaeochromocytoma Neuroendocrine adrenal tumour secreting catecholamines (dopamine, nor-adrenaline, adrenaline, metadrenaline and normetadrenaline).
Cushing's Syndrome Adrenal cortex tumour secreting excessive amounts of cortisol.
Conn's Syndrome Adrenal cortex adenoma secreting excessive amounts of aldosterone.
EXCLUDED
Women with non-functioning adrenal tumour.
Funding
This study is funded by SPARKS.
Ethics committee approval
The study has been approved by the Riverside Research Ethics Committee(REC reference number: 09/H0706/78).
Investigators
Catherine Williamson, Kimberly Lambert, Mandish Dhanjal, Imperial College London
David McCance, Royal Victoria Hospital
Download the Data Collection Form (DCF)
UKOSS Adrenal Tumours in Pregnancy Form
References
- a, b, c Robar C, Poremba J, Pelton J, Hudson L, Higby K. Current diagnosis and management of aldosterone-producing adenomas during pregnancy. The Endocrinologist 1998;8:403-08.
- ^ Grodski S, Jung C, Kertes P, Davies M, Banting S. Phaeochromocytoma in pregnancy. Intern Med J 2006;36(9):604-6.
- ^ Lindsay JR, Nieman LK. Adrenal disorders in pregnancy. Endocrinol Metab Clin North Am 2006;35(1):1-20.
- a, b, c Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing's syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab 2005;90(5):3077-83.
- ^ Ahlawat SK, Jain S, Kumari S, Varma S, Sharma BK. Pheochromocytoma associated with pregnancy: case report and review of the literature. Obstet Gynecol Surv 1999;54(11):728-37.
- ^ Schenker JG, Chowers I. Pheochromocytoma and pregnancy. Review of 89 cases. Obstet Gynecol Surv 1971;26(11):739-47.
- ^ Bakri YN, Ingemansson SE, Ali A, Parikh S. Pheochromocytoma and pregnancy: report of three cases. Acta Obstet Gynecol Scand 1992;71(4):301-4.
- ^ Matsumoto J, Miyake H, Isozaki T, Koshino T, Araki T. Primary aldosteronism in pregnancy. J Nippon Med Sch 2000;67(4):275-9.
