A Unique Case of Paraganglioma Unmasked by Intra-op Hypertension and Abdominal Lymphadenopathy (NKF-SCM 2022)
BP was elevated to 143/113, refractory to bolus anti-hypertensives and a nitroglycerin infusion; he ultimately required a nicardipine infusion for blood pressure control...Labs at the time of diagnosis included Cr elevated to 1.6 mg/dl, troponin peak 1.3 ng/ml, NT-proBNP 291 pg/ml, TSH 3, free plasma metanephrine 108 pg/ml, normetanephrine 7,987 pg/ml, fractionation of norepinephrine >1,200 pg/ml in the serum and >517 mcg/g in the urine, epinephrine 251 pg/ml serum and 21 mcg/g in urine, dopamine 1,144 pg/ml in serum, and chromogranin A 2,058 ng/ml...His BP was controlled on lisinopril and doxazosin with stable BP outpatient of 114/68...Chemotherapy and radiation can be offered as some cases are not ameable to surgery. Performing germline genetic testing should also be considered in such cases.