Endocrine Abstracts

Case report: A 68 year old lady was admitted for an elective partial hepatectomy for a solitary metastasis in the liver. Two years ago she had an uneventful colectomy for a colorectal cancer. During induction for her operation she was noted to be hypertensive {blood pressure (BP) 200/120 mm of mercury (Hg)}, though had not been observed to be so previously, and hence her partial hepatectomy had to be abandoned. She was commenced on atenolol and operation rescheduled. The second attempt at hepatectomy was aborted as well, as she was again found to be hypertensive (BP 330/220 mm of Hg). On this occasion the anaesthetist detected a lump, in the right side of the neck, which was present for the last twenty years and had never been troublesome. Twentyfour hour urinary catecholamines (mainly noradrenaline) were raised on three occasions. Meta-Iodobenzylguanidine scan showed a hot spot corresponding to the right cervical mass. An MRI scan showed an encapsulated 7 cm×4 cm mass deep to the right common carotid artery and extending to the pharynx. Her serum calcium, thyroid function, parathyroid hormone, parathyroid hormone related peptide and calcitonin were normal. She was adequately alpha and beta blocked with phenoxybenzamie (80 mg bd) and propranolol (40 mg tds). Her peri-operative period was uneventful and a 77 gram mass was removed from the neck. Biopsy confirmed paraganglioma.

Comments: Paragangliomas are tumours arising from extra-adrenal medullary neural crest derivatives- sympathetic ganglia (from neck to bladder), carotid body, vagal body, mediastinum, aorta, organs of Zuckerkendl and pelvis. This patient had the paraganglioma for twenty years but she was never symptomatic. Surprisingly, she did not have any peri-operative hypertensive crisis during her previous colectomy.