title: Catecholamine-secreting carotid body paraganglioma: successful preoperative control of hypertension and clinical symptoms using high-dose long-acting octreotide.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Omayma
authors.initials: O
authors.lastname: Elshafie
authors.affiliation: Department of Surgery, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Al Badaai
authors.affiliation: Department of Surgery, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Khalifa
authors.initials: K
authors.lastname: Alwahaibi
authors.affiliation: Department of Pathology, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Asim
authors.initials: A
authors.lastname: Qureshi
authors.affiliation: Department of Radiology, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Samir
authors.initials: S
authors.lastname: Hussein
authors.affiliation: Department of Radiology, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al Azzri
authors.affiliation: Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Ali
authors.initials: A
authors.lastname: Almamari
authors.affiliation: Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
authors.forename: Ncholas
authors.initials: N
authors.lastname: Woodhouse