Hypertension With Negative Metaiodobenzylguanidine Scintigraphy

Abstract

This clinical case illustrates the necessity of early detection of secondary hypertension. The patient had main signs attributable to the hypersecretion of catecholamines, including the triad signs, a severe and aroxysmal hypertension, and secondary diabetes. Moreover, urinary normetanephrines were significantly elevated. Severe hypertension associated with suggestive signs of catecholamine excesses and acute cardiological complications should lead to the screening of PPGL.3 The diagnosis is based on the determination of plasma-free metanephrines or fractionated urinary metanephrines (sensitivity and specificity higher than 90%).6 In case of confirmed hypersecretion, imaging is essential to locate the tumor. The first-line examination should be a thoraco- abdominopelvic computed tomography. Functional imaging, such as PET-18FDG (18F-fluorodeoxyglucose), PET-18F-DOPA, or 68Gallium-labeled somatostatin analogue PET, must be combined to confirm the diagnosis and look for other locations or metastases.2 123I-MIBG scintigraphy is not sensitive enough for paragangliomas developing alongside ympathetic and parasympathetic ganglia. In this clinical case, PPGL diagnosis should not have been ruled out by the negative results of MIBG.10 123I-MIBG scintigraphy scintigraphy should not be used as a first-line diagnostic technique when PGL is suspected. This delayed management increased the risk of the patient and her baby to severe complications or death via multivisceral failure due to catecholamine hypersecretion.11 Multidisciplinary meetings in reference centers are recommended.