Abstract P119: Severe Paroxysmal Hypertension In Patient With Gastric Neuroendocrine Tumor Detected By PET Dotatate Imaging

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Neuroendocrine tumors (NET) are rare neoplasms originating from neuroendocrine cells in the endocrine, gastrointestinal, or bronchopulmonary systems. When symptomatic, patients may present with paroxysmal HTN. A 51-year-old woman with CAD and prior CABG presented to the hospital with sudden onset headache and BP in the 200s/90s. Her physical exam was unremarkable. ECG showed new T wave inversions in leads V1 and V2 and high-sensitivity troponin was elevated at 1827 ng/L. CT angiography of her head and neck was normal. Her HTN improved with IV labetalol and pain control. We admitted her for BP control and secondary HTN evaluation. Initial lab findings were unremarkable (see table). A renal artery ultrasound showed no renal artery stenosis. CT of her chest, abdomen, and pelvis showed no evidence of NET. She continued to have paroxysms of severe HTN, initially controlled with IV medications, then transitioned to an oral four-drug regimen prior to discharge. Fractionated plasma metanephrines and catecholamines, and 24-hour urine fractional metanephrines were obtained (results pending at time of discharge).Follow up testing showed elevated urinary metanephrines and Chromogranin levels (see table), suggestive of NET. A Ga-68 PET-DOTATE scan showed a focus of increased activity in the anterior stomach. Endoscopy revealed a gastric body lesion, identified as grade 2, well-differentiated NET on biopsy. The patient underwent laparoscopic wedge gastrectomy with clear margins. Her headaches resolved, and BP improved. This case demonstrates the utility of Ga-68 PET DOTATE imaging in determining the presence of NET, not detected by CT images, as the reason for severe, paroxysmal HTN.

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