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1/4. Persistent visual loss after retinochoroidal infarction in pregnancy-induced hypertension and disseminated intravascular coagulation.

    A 40-year-old woman had pregnancy-induced hypertension, disseminated intravascular coagulation (DIC), choroidal infarction, and magnetic resonance imaging (MRI) high-signal abnormalities in the occipital regions. With successful treatment of the hypertension and spontaneous resolution of the DIC, the MRI signal abnormalities resolved, but visual acuity remained decreased because of damage to the retina and choroid. This case demonstrates that pregnancy-induced hypertension, particularly if combined with DIC, may produce infarction of the retina and choroid and persistent visual loss even if the effect of this condition on the occipital lobes is limited to reversible vasogenic edema. ( info)

2/4. Peripartum hypertension from pheochromocytoma: a rare and challenging entity.

    BACKGROUND: pheochromocytoma, a rare and usually curable cause of hypertension, is characterized by symptoms and signs related to increased catecholamine secretion. pregnancy can elicit clinical manifestations of otherwise unrecognized pheochromocytoma. methods AND RESULTS: Four women, ranging in age from 27 to 37 years, were referred to the hypertension clinic with the following presentations: 1) a 35-year-old woman, diagnosed with gestational hypertension and headaches during the third trimester of her pregnancy and 5 months after delivery, was hospitalized with pulmonary edema. echocardiography revealed severe dilated left ventricular (LV) dysfunction. Cardiac function was normalized after surgical resection of a pheochromocytoma from her left adrenal; 2) a 37-year-old woman suffered from preeclampsia, persistent hypertension and orthostatic hypotension after a cesarean section. A diagnostic work-up revealed a catecholamine-secreting paraganglioma in the retroperitoneum. The patient underwent a laparosopic resection of the tumor; 3) a 27-year-old woman suffered from hypertension and episodes of palpitations, sweating, and dyspnea in the first trimester of her pregnancy. An ultrasound revealed a 5-cm mass in the left adrenal. She underwent a left adrenalectomy at the 17th week of pregnancy, which confirmed the diagnosis of pheochromocytoma; 4) a 34-year-old woman, at the 26th week of pregnancy, presented with an acute loss of vision and blood pressure of 230/140 mm Hg. Fundoscopy showed papilledema with soft exudates in both eyes. Chemical studies were positive and imaging revealed a left adrenal pheochromocytoma. Despite aggressive medical treatment, fetal distress mandated a laparotomy at the end of the 28th week of pregnancy. A healthy newborn was delivered and resection of the adrenal tumor confirmed the diagnosis of pheochromocytoma. CONCLUSIONS: Although rare, pheochromocytoma can cause severe peripartum hypertension. Screening for pheochromocytoma, ideally with plasma-free metanephrines, should be considered in cases of peripartum hypertension. ( info)

3/4. A case of isolated peripartum elevation of alkaline phosphatase in pregnancy complicated by gestational diabetes.

    Several isoenzymes of alkaline phosphatase are present in pregnancy, the most common are of liver, bone, and placental origin. We report a case of pregnancy complicated by hypertension and gestational diabetes, in which an extremely high elevation in bone isoenzyme was noted during labor. The enzyme level returned to normal by six weeks postpartum. Elevations in total serum alkaline phosphatase during pregnancy or labor cannot be assumed to arise from the placenta, and should be further investigated to determine the specific isoenzyme. ( info)

4/4. A rare case of early onset nephrotic syndrome in pregnancy.

    nephrotic syndrome occurs very rarely, about 0.012-0.025% of all pregnancies. Here, we report a rare case of early onset nephrotic syndrome developing de novo in the 17th week of pregnancy. A renal biopsy was done and the specimens revealed typical features of focal segmental glomerulosclerosis. The patient had a progressive clinical course of disease despite steroid treatment. Suffering from severe intrauterine growth restriction, the fetus died in utero. After delivery, steroid treatment was continued. The patient had normal renal function with a decrease in proteinuria in the second and fifth month postpartum. This report points out the poor fetal prognosis associated with an early onset nephrotic syndrome. Pregnant patients with early onset nephrotic syndrome should be carefully evaluated for the presence of chronic renal disease, and primary renal pathology should be included in the differential diagnosis of massive proteinuria in early pregnancy. ( info)

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