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Paroxysmal hypertension unmasked by a rare urethral paraganglioma

Journal of Human Hypertension (2026)Cite this article

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Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors arising from the adrenal medulla or the sympathetic nervous system. These tumors are characterized by the synthesis, secretion and release of excessive catecholamines, leading to a series of clinical manifestations, including paroxysmal elevation of blood pressure (BP), headache, palpitations, diaphoresis, nausea, fatigue, anxiety, and metabolic disturbances [1]. Paragangliomas (PGLs) refer specifically to tumors located in extra-adrenal sites [2]. Within this category, genitourinary (GU) PGLs are exceedingly rare, with a notably low reported incidence [3]. This report presents a rare case of urethral paraganglioma (UPG) manifesting as paroxysmal hypertension, which was precisely diagnosed by fluorine-18-L-dihydroxyphenylalanine (18F-DOPA) positron emission tomography/computerized tomography (PET/CT).

A 61-year-old woman presented to West China Hospital in October 2024 with a seven-year history of paroxysmal hypertension and palpitations. During the past seven years, her BP exhibited intermittent fluctuations, reaching a maximum value of 220/120 mmHg, with each episode lasting several minutes. Prior evaluations at other institutions included ambulatory blood pressure monitoring (ABPM) and examinations for hypertension-mediated organ damage (HMOD). ABPM results revealed mean 24-hour, daytime, and nocturnal BP values of 107/71 mmHg, 108/71 mmHg, and 103/69 mmHg, respectively. HMOD examinations identified only an atherosclerotic plaque in the left internal carotid artery. On the basis of these findings, the patient was initially prescribed irbesartan 75 mg and atorvastatin 20 mg once daily. However, the patient experienced dizziness and hypotension following antihypertensive administration and subsequently discontinued the medication.

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Fig. 1: Multimodality imagings, histopathological observation, and positive immunohistochemical indicators of the urethral paraganglioma in this case.

Data availability

The data used in the study are available from the corresponding author upon reasonable.

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Acknowledgements

We sincerely thank the patient for her cooperation in this case report. She signed the informed consent form and agreed to publication. We also appreciate the financial support from the Science and Technology Program of the Tibet Autonomous Region (Grant number: XZ202303ZY0004G).

Funding

Science and Technology Program of the Tibet Autonomous Region (Grant number: XZ202303ZY0004G).

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Author notes

  1. These authors contributed equally: Xin Zhang, Xiangyu Yang.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China

    Xin Zhang, Xiangyu Yang & Xiaoping Chen

  2. Department of Internal Medicine, Xizang Hospital of West China Hospital, Sichuan University, Lhasa, 851400, People’s Republic of China

    Kangzhu Baima

  3. Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China

    Minggang Su

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  1. Xin Zhang
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Contributions

Drafting the manuscript: Xin Zhang and Xiangyu Yang. Data collection: Baima Kangzhu and Xin Zhang. Correction: Minggang Su and Xiaoping Chen. Approval of the final version for publication: all the authors.

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Correspondence to Minggang Su or Xiaoping Chen.

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All procedures performed in this study were in accordance with the ethical standards of the institutional policy of West China Hospital of Sichuan University, and written informed consent was obtained from the patient.

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Zhang, X., Yang, X., Baima, K. et al. Paroxysmal hypertension unmasked by a rare urethral paraganglioma. J Hum Hypertens (2026). https://doi.org/10.1038/s41371-026-01122-z

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