Endocrine Abstracts

We present the case of a 53 year old gentleman with recurrent bladder paraganglioma. He presented initially in 2010 with headache and blurred vision when passing urine. The tumour was surgically removed, BP normalized and his postoperative MIBG-scan was normal. The patient presented with hypertensive crisis 4 years later with a suspicion of tumor recurrence, confirmed biochemically and radiologically. Treatment with phenoxybenzamine and bisoprolol resulted in adequate BP control. Plasma normetanephrine 5111 pmol/l (120–1180), plasma metanephrine 300 pmol/l (80–510) and Plasma 3-methoxytyramine 452 pmol/l (0–180). CT Abdomen and Pelvis showed a 15 mm bladder mass. No adrenal pathology. CT chest showed a soft tissue mass in left lung apex eroding left 3rd rib with pleural effusion. USS guided biopsy and histology was suggestive of neuroendocrine cells. Overall picture suggestive of metastasis. ⁽⁶⁸⁾Ga-DOTATATE PET/CT showed avid soft tissue nodule associated with the bladder, compatible with phaeochromocytoma recurrence. There were multifocal avid deposits in the bones, the largest at the proximal left third rib with soft tissue extension. ⁽¹⁷⁷⁾Lu-DOTA-TATE ablation therapy was commenced following MDT discussion. Post Lu-177 imaging still showed avid uptake in the ribs and awaiting further treatment cycle.

We present a case where Lutetium (Lu) ablation is used as a treatment option for metastatic paraganglioma of the urinary bladder. This is a rare presentation. Most tumors are benign. Patients with localized tumours have a favourable prognosis following treatment but lifelong follow up is essential as delayed recurrence could occurs as seen in our patient.When patients present with metastatic disease, survival is greatly reduced and palliative care is the norm (1) In patients with DOTATATE avid metastatic lesions, ⁽¹⁷⁷⁾Lu-DOTA-TATE ablation therapy has emerged as a new modality of treatment with less toxicity leading to lasting remission in some cases.