A Case of Paraganglioma and Multifactorial Cardiogenic Shock in a Young Man

Lennon M, Suttie J

Introduction

Paraganglioma are neoplasms of eural crest cells origin derived from the paraganglia of the sympathetic and parasympathetic systems. Functionalor secretory paragangliomas manifest

with signs of catecholamine excess specifically excessive sweating, flushing and hypertension. If non-functional they may remain undiagnosed or are picked up incidentally on imaging and can cause cardiac complications if untreated. A timely diagnoses of secretory paragangliomas is critical because resection is generally curative. This is the case of a young male who presented with a hypertensive crisis and was found to have several paragangliomas on imaging.

Case Presentation

A 34 year old obese male presented to the ED hypertensive (210 systolic), nauseous and vomiting and bradycardic (HR 54) having had an alcoholic binge the days before and been on duromine for weight loss in the weeks leading up to that. In hospital he started to

destabilise with saturations of 75 – 80% and echocardiogram revealing an ejection fraction of 20%. Abdominal CT revealed 3 left sided para-aortic functional paragangliomas. He was transferred to a large metropolitan hospital in which he was further investigated and 2 of the 3 paragangliomas were resected. After 12 months his cardiac function has returned to

normal is otherwise fully recovered.

Conclusion

In cases of young patients presenting with a hypertensive crisis neuroendocrine tumours should be considered and excluded as a differential even if multiple possible more common causes exist (e.g. familial, medications, obesity, caffine/other drugs).