BACKGROUND: Hypertension is the most common medical complication of pregnancy. 
Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious 
perinatal morbidity and mortality.
METHODS: A patient with severe hypertension, postpartum pulmonary edema, and a 
recognized pheochromocytoma is described.
RESULTS: Abdominal palpation after vaginal childbirth reproduced the diagnostic 
triad of hypertension, headaches, and palpitations. Magnetic resonance imaging 
established the correct diagnosis before biochemical confirmation of excess 
catecholamine production. The patient responded to alpha-adrenergic receptor 
blockade with control of her severe hypertension and clearing of pulmonary 
edema. The best time to diagnose a pheochromocytoma is before delivery because 
vaginal childbirth stimulates the release of lethal amounts of catecholamines.
CONCLUSIONS: The physician who delivers babies must distinguish between labile 
hypertension and paroxysmal hypertension. Most experts believe that a 
spontaneous vaginal delivery is contraindicated when the patient has a 
pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma 
is unusual. The profound pressor response elicited by palpation of the 
postpartum abdomen, the failure of medications usually effective in the 
treatment of a hypertensive crisis, and the use of magnetic resonance imaging to 
confirm a functioning adrenal adenoma are the features unique to this case.