Multidisciplinary Approach to C-Section with Paraganglioma Mass Resection

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Paragangliomas (PGLs) are extra-adrenal neuroendocrine/catecholamine secreting tumors derived from paraganglia of the sympathetic and parasympathetic nervous systems. They are extremely rare and are found in less than 1 case per 100,000 individuals each year. PGL can pose a similar clinical picture to gestational hypertension and/or pre-eclampsia which are far more common diagnoses. If unrecognized, however, paragangliomas are associated with high maternal and fetal morbidity and mortality rates and are considered a very serious condition. Patient is a 27-year-old female G1P0 who was admitted for an extended antepartum stay for chronic hypertension with superimposed pre-eclampsia with severe features. While in the hospital, the patient's blood pressure was poorly controlled with labetalol.

Patient began experiencing "episodes" of severe blood pressure ranges in which she became hypertensive and tachycardic with headaches followed by bradycardia. These episodes prompted investigation of secondary causes of hypertension and endocrinology was consulted. Endocrinology ordered serum catecholamine levels and found normal metanephrine levels with elevated normetanephrine levels raising suspicions for paraganglioma. She was started on Doxazosin for alpha blockade. A multidisciplinary team was assembled including Surgical Oncology, Endocrinology, Advanced Heart Failure Cardiology, Anesthesia, Critical Care Surgery, and Maternal Fetal Medicine. The team decided a c-section with resection of the mass immediately after delivery was recommended for 34 weeks gestation but delayed to 35 weeks per the patient's wishes. The patient underwent extensive pre-operative counseling by anesthesia and was found to be an ASA 4.

The anesthetic goal was optimal pain control to avoid further tachycardia and hypertension induced by pain. After multiple care conferences, the patient ultimately agreed to a cesarean section under general anesthesia. The patient underwent a planned c-section, followed by an exploratory laparotomy, resection of left retroperitoneal mass, cystoscopy, and left ureteral catheter placement. Her airway was managed with intubation, and she had a peripheral IV, central line, and arterial line. The patient did require IV pressors including phenylephrine and norepinephrine intraoperatively for hemodynamic instability. The baby was able to be delivered without complication. The retroperitoneal mass was resected without issue. Patient was transferred to the ICU with an arterial and central line and monitored closely for hypotension post paraganglioma mass removal. She received TAP blocks postoperatively by anesthesia for pain control. Patient and baby were discharged 5 days post-op and would follow up with oncology.

This case is significant for the anesthetic challenges that were overcome to achieve hemodynamic stability. Thorough preoperative assessment, strong interdisciplinary communication, and extensive patient education and counseling amounted to the success of this case. Through proactive multimodal pain management and close intra and postoperative monitoring, the patient had a safe and successful delivery and mass resection.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1972

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