A 5-year delayed paraganglioma diagnosis: three pregnancy losses and a transient ischemic attack following false-negative testing—a case report

Paragangliomas are rare neuroendocrine tumors that secrete catecholamines, potentially causing severe cardiovascular and obstetric complications. Their variable presentation and low prevalence often delay diagnosis. A 25-year-old woman experienced 5 years of resistant hypertension, three pregnancy losses, and a transient ischemic attack. Initial biochemical testing, including 24-hour urine vanillylmandelic acid (VMA) and metanephrine levels, was normal, and an adrenal-focused abdominal CT scan had been interpreted as normal. A repeat evaluation following proper preanalytical preparation indicated significantly higher urinary normetanephrines and plasma free normetanephrine, while abdominal computed tomography angiography (CTA) revealed a retroperitoneal mass consistent with a paraganglioma. Maintaining clinical suspicion and using high-sensitivity biochemical testing with targeted imaging are essential to prevent diagnostic delays and reduce morbidity in patients with peculiar symptoms.