A Unique Case of Metastatic Paraganglioma in a Patient With Parkinson Disease

We describe the case of a patient in his 70s with Parkinson disease (PD) who had an incidental pheochromocytoma with mesenteric secondaries. Although the literature contains a few case reports of patients with PD who have incidental pheochromocytoma, this is the first case report of a patient with PD and metastatic paraganglioma (PPGL). The diagnosis was confirmed by a metaiodobenzylguanidine radioisotopic scan, along with increased levels of catecholaminergic products and byproducts in the urine. Genetic predisposition to PD and PPGL appears paradoxical, as PPGL is associated with the pathologic stabilization of hypoxia-inducible factor-1α. In contrast, PD involves the disruption of hypoxia-inducible factor-1α activity. Thus, the coexistence of these 2 conditions should be very rare, and, based on the paucity of such cases in the literature, this appears to be the case.