Secondary hypertension: A rare cause

Abstract

A 13-year-old, previously asymptomatic girl was admitted with features of tuberculous meningitis. She was found to be hypertensive and further investigations revealed an extra-adrenal paraganglioma. Tuberculous meningitis and paraganglioma could be chance associations. Paraganglioma is a very rare and potentially lethal cause of secondary hypertension. We are reporting a very rare disease, which has come to light in a most unexpected manner.

Anesthetic management of a patient with undiagnosed paraganglioma -a case report-

“…Pheochromocytoma and secreting extra-adrenal paraganglioma are the cause of the secondary hypertension in approximately 0.1% of hypertensive patients and the prevalence is estimated to be 1 per 100,000 persons per year or less [ 7 ]. Unlike pheochromocytoma, which have been described as having a 10% malignancy rate, paraganglioma, especially the abdominal extra-adrenal have a higher rate of malignancy ranging from 14% to as high as 50% [ 1 ] and retroperitoneal paragangliomas have a more genetic background [ 1 , 3 , 4 , 8 ]. Therefore genetic testing should be offered to patients diagnosed with extra-adrenal paraganglioma, particularly in patients who are young, have multiple tumors, or have a family history of malignancy [ 3 ].…”

“…On the other hand pheochromocytoma may produce either norepinephrine or mainly ephinephrine which act potentially in β 2 - adrenal receptors of the skeletal muscle vasculature causing vasodilation that results in hypotension [ 11 ]. This difference in secretory pattern is related to the presence of phenylethanolamine N-methyltransferase which converts norepinephrine to epinephrine [ 8 ]. The best screening test for a functional extra-adrenal paraganglioma is sampling of 24 hr unine metanephrines.…”