AUTHOR=Ma Xiangping , Chen Zhen , Xia Peng , Zhang Chunmei , Yan Keqiang , Fan Yidong , Wang Yingli , Ti Yun , Bu Peili 

TITLE=Giant Paraganglioma Complicated With Catecholamine Crisis and Catecholamine Cardiomyopathy: A Case Report and Review of the Literature

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.790080

DOI=10.3389/fendo.2021.790080

ISSN=1664-2392

ABSTRACT=Abstract
Background: Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors which overproduce catecholamines. Heart failure and myocardial infarction caused by paraganglioma complicated with catecholamine crisis are the most common causes of death in PPGL patients before surgery. When giant paraganglioma is complicated with catecholamine crisis, treatment brooks no delay.
Case summary: A 49-year-old man had episodic sweating, tachycardia with irregular pulse, and headaches 5 days before. And then he showed up with chest pain and wheezing for 1 day. Meanwhile, he developed symptoms of recurrent severe abdominal pain, loss of consciousness and his blood pressure was severely instable (from 70/40 mmHg to 300/200 mmHg). First, the electrocardiogram showed ventricular tachycardia. And then we noticed the waves of ST-segment elevation, but we did not find significant abnormalities in coronary angiography. Abdominal CT and MRI revealed a giant lesion with bleeding or infection in the retroperitoneal adrenal area. These imaging findings were confirmed during surgery, and the vascular adhesion between the retroperitoneal tumor and the inferior vena cava, left and right renal vein. After successful resection of the tumor, postoperative pathology confirmed paraganglioma, the patient pulled through and discharged quickly. 
Discussion: This is a rare case of giant paraganglioma complicated with catecholamine crisis and catecholamine cardiomyopathy. We can diagnosis this disease greatly by elevated norepinephrine, and it is a gold biochemical standard now. Standard treatment is surgical resection, which is effective in treating this rare neuroendocrine tumor.