A patient with pheochromocytoma and paraganglioma in different presentation times

The patient is a 15 years old boy admitted for excision of extra adrenal tumor. He complained from intermittent headache and palpitation and diaphoresis.Symptoms have been present from almost a few months before than refer to hospital.Blood pressure was measured and mild hypertension was detected. Therefore holter monitoring also was done and had been proven that patient was involved by persistent hypertention.According to previous history , patient was investigated for 24-h collective cathecolamins of urine (neurmetanephrine, metanephrine, neurepinephrin , epinephrine, VMA and HWA).The patient had been underwent open adrenalectomy for pheochromocytoma almost last 3 years ago.In recent admission, after detection of rising urine cathecolamins more than 4 times upper limit of normal range. Immediately, imaging was done and extra adrenal tumor was detected. After 10 days control of blood pressure by alfa blocker, laparascopic excision of tumor was done.Hypertension and other symptoms subsided and antihypertensive drugs discontinued.Pathologic study was shown nesting (zellballen), polygonal, spindle shaped cells in rich vascular network due to extra adrenal paraganglioma.It s interesting that genetic results about RET was undetected and other mutations are under investigating