Catecholamine-secreting carotid body paraganglioma: successful preoperative control of hypertension and clinical symptoms using high-dose long-acting octreotide

• Published in: Endocrinology, diabetes & metabolism case reports diabetes & metabolism case reports, 2014-07, Vol.2014, p.140051-140051
• Main Authors: Elshafie, Omayma, Al Badaai, Yahya, Alwahaibi, Khalifa, Qureshi, Asim, Hussein, Samir, Al Azzri, Faisal, Almamari, Ali, Woodhouse, Nicholas
• Format: Article
• Language: English
• Subjects: Adrenal; Adult; Alpha-blockers; Amlodipine; Beta-blockers; Blood pressure; Carotid body paraganglioma; Catecholamine secreting carotid body paraganglionoma; Chromogranin A; CT scan; Diabetes mellitus type 1; Dopamine; Female; Hearing loss; Histopathology; Hypertension; Indapamide; Insulin; Labetalol; Lisinopril; MIBG scan; Neuroendocrine markers; Neuroendocrine tumour; Noradrenaline; Norepinephrine; Novel Treatment; Octreotide; Octreotide scan; Oman; Other; Palpitations; Paraganglioma; Phaeochromocytoma; Tinnitus
• ISSN: 2052-0573; 2052-0573
• DOI: 10.1530/EDM-14-0051

Summary A 48-year-old hypertensive and diabetic patient presented with a 10-year history of progressive right facial pain, tinnitus, hearing loss, sweating, and palpitations. Investigations revealed a 5.6 cm vascular tumor at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20 mg od and amlodipine 10 mg od and 100 U of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP) was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE) level, 89 000 pmol/l, and chromogranin A (CgA) level, 279 μg/l. Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100 μg 8 h, the NE level dropped progressively from 50 000 to 25 000 pmol/l and CgA from 279 to 25 μg/l. Treatment was therefore continued with labetalol 200 mg twice daily (bid) and long-acting octreotide-LA initially using 40 mg/month and later increasing to 80 mg/month. On this dose and with a reduced labetalol intake of 100 mg bid, BP was maintained at 130/70 and her symptoms resolved completely. CgA levels returned to normal in the first week and these were maintained throughout the 3 month treatment period. During tumor resection, there were minimal BP fluctuations during the 10 h procedure. We conclude that short-term high-dose octreotide-LA might prove valuable in the preoperative management of catecholamine-secreting tumors. To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP. Learning points The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma. Control of catecholamine secretion using high-dose octreotide. This is a report of a rare cause of secondary diabetes and hypertension.