Metastatic paraganglioma: management of orthostatic hypotension - a case report

Metastatic paragangliomas are rare tumours, which characteristically secrete high levels of catecholamines, thereby giving rise to symptoms such as headaches, palpitations and profuse sweating. Orthostatic hypotension also results from these types of tumours, however the aetiology of this remains unclear. Here we describe a 40 year old lady with metastatic paraganglioma whose initial diagnosis was made at age 10. Following surgical resection and radioactive ablation, the tumour recurred in later life and she developed severely debilitating orthostatic hypotension, rendering her virtually bed-bound. We present our experience of her in-and out-patient management, balancing the need to control lifethreatening blood pressure surges with that to minimize worsening of orthostatic hypotension.