Endocrine Abstracts

Paraganglioma is a rare neuroendocrine tumour. There are few case reports in the literature describing vaginal paraganglioma to date. We present the case of a 37-year-old female referred to endocrinology services with symptomatic hypertension, initially noted during her first pregnancy three years prior. This was on a background of a vaginal paraganglioma diagnosed in 2006 which was excised by gynaecology services without complication. Her first pregnancy in 2021 was notable for symptoms of palpitations and headache with an episode of hypertension at 39/40 gestation requiring a short course of labetolol. This was deemed to be as a result of gestational hypertension. She reported hyperhidrosis and anxiety post-partum with further symptoms of hypertension 6 months after delivery. Symptoms were again noted at 37/40 gestation during her second pregnancy in 2023 with documented hypertension. A C-section was performed at 38/40 due to reduced foetal movements with subsequent large post-partum haemorrhage. Cross-sectional imaging revealed pelvic lymphadenopathy at that time, presumed to be reactive secondary to intra-abdominal haemorrhage. An MRI pelvis was arranged 6 months post-partum due to persistent hypertension and elevated urinary normetadrenaline and noradrenaline, which revealed a right-sided 1.2cm vaginal vault lesion with persistent pelvic lymphadenopathy. Her case was discussed at the gynaecology-oncology and neuroendocrine multi-disciplinary team meetings with subsequent FDG-PET-CT confirming MRI findings without distant metastases. The patient awaits surgical debulking and a gallium-PET scan and has been commenced on Doxazosin peri-operatively while breastfeeding. There are few case reports in the literature of vaginal paraganglioma with a review in 2022 citing only eleven cases, one of which was associated with a SDHB genetic variation. This case highlights the importance of lifelong surveillance in patients with paraganglioma.