INTRODUCTION
Multiple Endocrine Neoplasia (MEN) 2A is an autosomal dominant syndrome
characterized by medullary thyroid carcinoma (MTC), pheochromocytoma
(PCC) and parathyroid tumors.[1-4] Caused by germ-line mutation in
the RET proto-oncogene located on chromosome 10, MEN-2A is a subtype of
the MEN-2 syndrome and is the more commonly encountered clinical variant
(accounting for 75% cases) as opposed to MEN-2B.[5,6] Almost 90%
afflicted individuals manifest with MTC while PCC and parathyroid tumors
are noted in upto 40-50% and 20-30% cases respectively. As the disease
may present with polyglandular involvement, screening of other endocrine
organs is imperative once any single organ involvement is detected.
Current literature on diagnosis and management of MEN-2A syndrome in
pregnancy is scant and largely comprises case series or case reports.
Most patients were incidentally detected to have hypertension during
routine antenatal screening and found to have an underlying
pheochromocytoma. The limitations imposed by pregnancy both in terms of
restricted imaging options due to radiation exposure to the fetus and
restricted period of surgical intervention in the second trimester makes
the management of this situation challenging in most cases. We share our
experience of a young woman with MEN 2A syndrome who became pregnant
immediately post adrenalectomy for pheochromocytoma and had to undergo
surgery for medullary thyroid carcinoma in second trimester during a
nationwide lockdown due to the ongoing COVID pandemic. The case
highlights the various challenges we faced in patient management,
surgical intervention, post-operative care and follow up amidst travel
restrictions during the lockdown along with how these challenges were
overcome through multidisciplinary teamwork, teleconsultation services
and shared decision making with the patient which led us to a successful
outcome in a difficult clinical scenario, in such challenging times.