Endocrine Abstracts

Objective: We present two cases of patients with Paraganglioma of the urinary bladder wall, illustrating the differences in diagnosis and management.

Case 1: An 80-year-old female known to have diabetes and hyperthyroidism (treated) presented to her urologist with painless hematuria. Cystoscopy was done and bladder polyps were biopsied. Results of the tumors sampled showed paraganglioma of the urinary bladder wall, although patient was asymptomatic. She presented to the endocrinology clinic to rule out pheochromocytoma. She has long-standing hypertension well-controlled with three medications (CCB, ARB, BB). She denied headaches or syncope especially upon micturition. No flushes or palpitations. Plasma metanephrines, dopamine and normetanephrines were checked and were negative, ruling out secretory pheochromocytomas. She underwent TURBT later for complete resection of the tumor, the pathology of which was consistent again with Paraganglioma of the urinary bladder wall. Patient remains asymptomatic afterwards with good control of her blood pressure despite the diagnosis.

Case 2: A 32-year-old male previously healthy presented to the urology clinic with 9 months history of headaches and palpitations following micturition. He denied any obstructive or irritative lower urinary tract symptoms. Family history was unremarkable for any related conditions. Patient had his vital signs monitored before and after micturition, and were found to be: Blood pressure and heart rate were 130/80 mmHg and 75 bpm before voiding, rising to 170/100 mmHg and 100 bpm upon bladder emptying. His urinalysis showed microscopic hematuria. Pelvic ultrasound revealed a left bladder wall polyp measuring 35 × 23 mm seen also on CT scan. Cystoscopy showed a submucosal pulsating mass 3 cm in size. He had elevated plasma free normetanephrines (1.90 nmol/l; normal < 0.93). His 24 h urine catecholamine and metanephrine levels were within normal limits. Iodine 131-MIBG scintigraphy showed no other sites involved. Patient received an α-adrenergic blocker as a preparation for surgery, along with vigorous hydration. A successful partial cystectomy was done and was uneventful, without blood pressure fluctuations. Immunostaining was strongly positive for synaptophysin and chromogranin, in favor of a paraganglioma. Patient remained asymptomatic upon long term follow-up.

Conclusion: Bladder wall paragangliomas are variable in their nature and their presentation. Tumors range from non-secretory masses in asymptomatic individuals to excessively secreting catecholamine leading to life threatening hypertension and tachycardia.