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Bladder paragangliomas are exceptionally rare neuroendocrine tumours, accounting for just 0.05% of all bladder cancers, often resulting in delayed diagnosis.

Shekhda et al. present the case of a 36-year-old woman with a 10-year history of post-micturition palpitations, headaches and episodic hypertension. Biochemical tests revealed elevated urinary normetanephrines, and imaging identified a 123I-MIBG-avid bladder mass, which, interestingly, was non-avid on 68Ga-DOTATATE positron emission tomography/computed tomography. She was optimised with preoperative alpha-blockade, and underwent a successful robotic partial cystectomy without complications.

This case highlights the importance of early recognition of bladder paragangliomas in patients with unexplained post-micturition symptoms. A multimodal imaging approach is crucial for precise localisation, while preoperative alpha-blockade remains essential to prevent intraoperative hypertensive crises. The successful outcome also highlights the value of a multidisciplinary team – including expertise in endocrinology, urology, radiology and pathology – in ensuring optimal management. Although no genetic mutations were identified, ongoing surveillance is vital, due to the potential risk of recurrence.

As awareness increases, this case emphasises the need to refine diagnostic strategies and perioperative protocols for these rare, but clinically significant, tumours.

Read the full article in Endocrine Oncology 5 e240044 https://doi.org/10.1530/EO-24-0044