Pediatric Suprarenal Paraganglioma Presented as Blurred Vision-A Case Report

Ocular manifestations of hypertensive retinopathy such as vision impairment or even loss associated with pheochromocytoma or paraganglioma were rarely reported. In this paper, we report a case of a fifteen-year-old girl with bilateral blurred vision for two months. Initial blood pressure (BP) was 218/159 mm Hg. Ophthalmoscopy showed bilateral hypertensive retinopathy with optic disc edema. Two-dimensional echocardiography revealed hypertrophy of the interventricular septum and left ventricular wall. Initial emergent hypertension was stabilized with phenoxybenzamine and a calcium channel blocker. Renal ultrasound and abdominal computed tomography revealed a huge right suprarenal tumor compressing renal hilar vessels. Urinary vanillylmandelic acid (VMA) level was 56. 5 mg/24 hr (normal, 2-7 mg/24 hr). Retroperitoneal suprarenal paraganglioma was highly suspected. Tumor resection was performed after blood pressure was stabilized for two weeks. Pathological study revealed a paraganglioma of 10×6.7×4 cm in size with suspicion of metastasis. Postoperative 18-fluorodeoxyglucose positron emission tomography scan revealed no metastasis. Her visual acuity, BP and VMA level returned to normal after tumor resection. While pediatric pheochromocytoma and paraganglioma are rare, blurred vision with hypertensive retinopathy may be induced by pheochromocytoma/ paraganglioma in children. It is worthwhile reporting our experience with a patient who presented with initial blurred vision caused by paraganglioma. (Acta Nephrologica 2011; 25: 196-200)