title: Catecholamine-secreting paraganglioma: the challenges of perioperative management.
abstract: An asymptomatic 48-year-old man presented with a right-sided neck mass. A CT scan demonstrated a lesion at the carotid bifurcation and an angiogram showed splaying of the carotid arteries. His plasma metanephrines were raised confirming a catecholamine-secreting paraganglioma. Metaiodobenzylguanidine single-photon emission CT showed focal high tracer uptake in the right of the neck. Histology revealed a tumour, arising within a nerve, composed of oval-shaped cells arranged in nested (zellballen) as well as in trabecular patterns. Immunohistochemistry was positive for neuroendocrine markers chromogranin A, synaptophysin and CD56. Preoperative management included an endocrinologist initiating α-adrenergic and β-adrenergic blockers. Intraoperatively, acute hypertension occurred whenever the tumour was manipulated. Close communication between the surgeons and the anaesthetist allowed for these episodes to be predicted and treated with fast-acting antihypertensives such as sodium nitroprusside. Postoperatively, the patient recovered well and his antihypertensives were discontinued.
authors.affiliation: ENT Surgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Eamon
authors.initials: E
authors.lastname: Shamil
authors.affiliation: Anaesthetic Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Brennan
authors.affiliation: ENT Surgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Piyush
authors.initials: P
authors.lastname: Jani
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002395:Catecholamines / Q000097:blood*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D019990:Perioperative Care; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery
chemical_list: D000959:Antihypertensive Agents; D002395:Catecholamines