A Case of Paraganglioma with Cyanotic Congenital Heart Disease

Norasyikin A Wahab, Beh Hui Chien, Mohd Rahman Omar, Aini Ab Aziz, Norlaila Mustafa, Norlela Sukor, Nor Azmi Kamaruddin

Abstract


Co-occurrence of cyanotic congenital heart disease (CCHD) and phaeochromocytoma (PCC) and paraganglioma (PGL) are rare, although some cases have been reported. We report a case of left paraganglioma in a 20-year-old lady with an underlying CCHD who underwent palliative Glenn shunt, subsequently developed polycythaemia and cavernous sinus thrombosis presented with palpitation, sweating, headache and hypertension of 3-months duration at the age of 17. The abdominal CT scan revealed an enhancing left paraaortic mass measuring 5.2 cm x 4.4 cm x 3.8 cm. A 24-hour urine catecholamine demonstrated raised noradrenaline level to six times upper limit of normal and hence diagnosis of left sympathetic (sPGL) was made. In view of the delayed diagnosis and significant morbidity associated with her condition, surgical treatment is no longer an option. Therefore, vigilant screening and early treatment of PCC-PGL in patients with CCHD are crucial in order to avoid significant morbidity and ensure a good quality of life.


Keywords


cyanotic congenital heart disease; paraganglioma; pheochromocytoma; hypoxia

References


Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;366: 665-75.

Fliedner SMJ, Lehnert H, Pacak K. Metastatic paraganglioma. Semin Onco. 2010; 37:627-37.

Opotowsky AR, Moko LE, Ginns J, et al. Pheochromocytoma and paraganglioma in cyanotic congenital heart disease. J Clin Endocrinol Meta. 2015;100:1325-34.

Zhao B, Zhou Y, Zhao Y, Zhao Y, Wu X, Bi Y, Luo Y, Ji Z, Rong S. Co-occurrence of pheochromocytoma-paraganglioma and cyanotic congenital heart disease: a case report and literature review. Frontiers Endocrinol. 2018;9:165.

Ponz de Antonio I, Ruiz Cantador J, González García AE, Oliver Ruiz JM, Sánchez-Recalde Á, López-Sendón JL. Prevalence of neuroendocrine tumors in patients with cyanotic congenital heart disease. Revista Española de Cardiología. 2017;70(8):673-5.

Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation. 1971;43:323-32.

Soltani A, Pourian M, Davani BM. Does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2016;15:6.

Amorim-Pires D, Peixoto J, Lima J. Hypoxia pathway mutations in pheochromocytomas and paragangliomas. Cytogenet Genome Res. 2016;150:227-41.

Baysal BE, Maher ER. 15 years of paraganglioma: Genetics and mechanism of pheochromocytoma-paraganglioma syndromes characterized by germline sdhb and sdhd mutations. Endocr Relat Cancer. 2015;22:71-82.

van Berkel A, Lenders JW, Timmers HJ. Diagnosis of endocrine disease: Biochemical diagnosis of pheochromocytoma and paraganglioma. Eur J Endocrinol. 2014;170:109-19.

Lenders JM, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: Which test is best? JAMA Intern Med. 2002;287:1427-34.

Ilias I, Pacak K. Current approaches and recommended algorithm for the diagnostic localization of pheochromocytoma. J Clin Endocrinol Metab. 2004;89:479-91.

Maurea S, Cuocolo A, Reynolds JC et al. Diagnostic imaging in patients with paragangliomas. Computed tomography, magnetic resonance and mibg scintigraphy comparison. Q J Nucl Med. 1996;40:365-71.

Corssmit EP, Romijn JA. Clinical management of paragangliomas. Eur J Endocrinol. 2014;171:231-43.

Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915-42.

Pacak K. Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab. 2007;92:4069-79.

Castilho LN, Simoes FA, Santos AM, et al. Pheochromocytoma: A long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy. Int Braz J Urol. 2009;35:24-31.


Full Text: PDF

Refbacks

  • There are currently no refbacks.