PARAGANGLIOMA AS CAUSE OF RESISTANT ARTERIAL HYPERTENSION: A CASE REPORT

Abstract

Objective: Approximately 3%of patients with resistant arterial hypertension are diagnosed with pheochromocytoma. On other hand, paragangliomas of the head and neck are rare, representing <0,5% of all head and neck tumors. They arise in a number of locations along the carotid sheath. Design and method: Herein, we present the case of a 66-year-old Caucasian woman (BMI 29,3 kg/m2) with resistant arterial hypertension (BP 160-170/100-110 mmHg while taking antihypertensive drugs: valsartan 320 mg/day, hydrochlorothiazide 25 mg/day, amlodipin 10 mg/day) and episodic headaches. Over the last 5 years prior to presentation, she had resistant hypertension and each year normal urinary metanephrine level and CT scan of the abdomen. Results: At the presentation a tumor (4,6x3,6x2,9 cm) was detected by ultrasound in the left submandibular region and laboratory tests detected a normal plasma metanephrine level - 0,16 nmol/l (reference values <0,36 nmol/l) and normal plasma 3-methoxytyramine level -<0,06 nmol/l (reference values<0,15 nmol/l) and increased plasma normetanephrine level - 3,25 nmol/l (reference values<1,05 nmol/l. The tumor was surgically removed and a carotid paraganglioma was confirmed histologically. After surgery, patient's blood pressure is controlled (130/80 mmHg) by taking a fixed combination valsartan 80/hydrochlorothiazide 6,25 mg /day). Conclusions: Patients with resistant arterial hypertension should be screened for secondary hypertension, even if such screening has already been done in previous years.