Hypertension in a teenager: a family affair

We present a young, lean, female patient following surveillance by the general practitioner for abnormally high blood pressure readings. Her grandmother died at a young age because of hypertension which shows her family has significant history for hypertension. Her symptoms and signs included feeling hot and nauseous following exercise, sweating and palpitations. Her young age and significant family history immediately prioritises secondary causes including phaeochromocytoma and familial syndromes causing hypertension. Urinary results showed significantly elevated norepinephrine, MRI scanning revealed a mass not within but adjacent to the right adrenal gland while CT-based scanning showed no other ectopics. The patient subsequently underwent surgical intervention at Great Ormond Street Hosptial and following a difficult procedure, that initially started laparoscopically and was converted to open, the tumour was excised. Histopathology and genetic analysis ultimately revealed the patient to have suffered from a paraganglioma type 4 syndrome with a missense mutation of the SDHB gene.