Paraganglioma in a young patient with asymptomatic severe hypertension: a case report and review of the literature

Hippokratia 2010; 14 (4):300-302

Ch. Koumaras, P. Anagnostis, M. Tzimou, I. Giavanidis, Th. Gossios, A. Antoniadis, Vg. Athyros, A. Karagiannis


We present a case of a 19-year old woman who was admitted to our department with a recently, and incidentally, diagnosed severe hypertension [220/140 mmHg systolic/diastolic blood pressure (BP)]. The patient was asymptomatic. The laboratory investigation demonstrated both elevated plasma norepinephrine (1807 pg/ml, normal range 120-350 pg/ml) and 24h urinary free catecholamines (483 ìg/24h, normal range <150 ìg/24h), making the diagnosis of a catecholamineproducing tumor highly probable. Although magnetic resonance imaging of the abdomen showed normal adrenal glands, it revealed a mass (4×4 cm) anterior to the inferior vena cava. The diagnosis of paraganglioma was confirmed by the 131Imeta- iodobenzylguanidine scintigraphy. Preoperatively, á- and â-adrenergic receptor blockers were administered. After successful resection of the tumor, the patient?s BP was restored to normal and remained stable during the 3-month follow up. Plasma and 24h urinary catecholamine levels were also normalized. In conclusion, it is important to consider paragangliomas as a possible cause of secondary hypertension and proceed to diagnosis and treatment as described above, since surgical removal of the tumor, especially in sporadic cases, may cure the patient.