RESUMO
UNLABELLED: 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 5.6âcm vascular tumor at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20âmg od and amlodipine 10âmg od and 100âU of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP) was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE) level, 89â000âpmol/l, and chromogranin A (CgA) level, 279âµg/l. Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100âµg 8âh, the NE level dropped progressively from 50â000 to 25â000âpmol/l and CgA from 279 to 25âµg/l. Treatment was therefore continued with labetalol 200âmg twice daily (bid) and long-acting octreotide-LA initially using 40âmg/month and later increasing to 80âmg/month. On this dose and with a reduced labetalol intake of 100âmg 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 10âh 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. LEARNING POINTS: 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.