BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5649
  • Rare disease

Diaphoresis and abdominal pain caused by extra-adrenal paragangliomas

  1. Martin Whyte
  1. Guy’s & St Thomas’s NHS Foundation Trust, London, UK
  1. Correspondence to Dr Mohammed Majid Akhtar, gogetmajid{at}


A 63-year-old lady presented with suprapelvic pain, weight loss and night sweats. On examination, she was noted to be hypertensive with a distended abdomen. Imaging (CT) revealed a 9.5 cm retroperitoneal mass with a high degree of vascularity and necrotic centre. The patient’s urinary and plasma catecholamines were significantly raised and subsequent radio-isotope scan suggested the tumour was likely to be of a neuroendocrine nature. A diagnosis of a malignant paraganglioma was made. Malignant paragangliomas derive from sympathetic tissue and secrete catecholamines. Diagnostic uncertainty might lead to biopsy of tumour but this carries a high-risk of catecholamine-induced complications such as hypertensive crisis, cardiac arrhythmias and cardiac ischaemia and must be avoided.


  • Competing interests None.

  • Patient consent Obtained.

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