title: Ischemic stroke and rhabdomyolysis in a 15-year-old girl with paraganglioma due to an SDHB exon 6 (Q214X) mutation.
abstract: BACKGROUND
  We report a 15-year-old girl with a recent diagnosis of type 2 diabetes mellitus who presented in malignant hypertensive crisis (BP 210/120 mm Hg). Abdominal CT showed an 8.2 x 4.7 x 7.0 cm mass in the region of the organ of Zuckerkandl. MIBG scan showed a single paraganglioma without metastatic foci. Plasma total metanephrines were 232,176.4 pmol/l [263-1052] with normetanephrine predominance. Pre-operative course was complicated by ischemic stroke in the left MCA and right thalamic regions, acute renal failure, rhabdomyolysis and congestive heart failure. She required massive doses of propranolol, phenoxybenzamine, doxazosin and metyrosine prior to surgery.
  
  
  RESULTS
  Pathology showed a Zellballen pattern, negative tumor margins and benign para-aortic lymph nodes. Mutation analysis of the succinate dehydrogenase type B (SDHB) gene revealed a heterozygous change of C to T at position 640 in exon 6 (Q214X) predicting an amino acid change to a stop codon.
  
  
  CONCLUSIONS
  We report a severe clinical phenotype in a patient with a paraganglioma affecting multiple organ systems, due to an SDHB mutation. SDHB mutation warrants close follow up and investigation of the family due to high malignant potential and risk of familial occurrence.
authors.affiliation: Department ofPediatrics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.forename: C
authors.initials: C
authors.lastname: Muratore
authors.forename: L
authors.initials: L
authors.lastname: Snelling
authors.forename: D E
authors.initials: DE
authors.lastname: Mandelbaum
authors.forename: R
authors.initials: R
authors.lastname: McEachern
authors.forename: S
authors.initials: S
authors.lastname: Mangray
authors.forename: M
authors.initials: M
authors.lastname: Faizan
authors.forename: J B
authors.initials: JB
authors.lastname: Quintos
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology; D005091:Exons / Q000235:genetics; D005260:Female; D018095:Germ-Line Mutation; D006333:Heart Failure / Q000209:etiology / Q000473:pathology; D006801:Humans; D006974:Hypertension, Malignant / Q000209:etiology / Q000473:pathology; D010220:Para-Aortic Bodies / Q000473:pathology; D010236:Paraganglioma, Extra-Adrenal / Q000235:genetics* / Q000601:surgery; D012186:Retroperitoneal Neoplasms / Q000235:genetics* / Q000601:surgery; D012206:Rhabdomyolysis / Q000209:etiology*; D020521:Stroke / Q000209:etiology*; D013385:Succinate Dehydrogenase / Q000235:genetics*
chemical_list: C108095:SDHB protein, human; D013385:Succinate Dehydrogenase