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Case Report Open Access

Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol

  • Authors:
    • Shucai Jiang
    • Ting Pan
    • Yanming Qu
    • Ke Gu
    • Guanjie Shang
    • Xiaoning Lan
    • Weihai Ning
    • Hongwei Zhang
  • View Affiliations / Copyright

    Affiliations: Department of Neurosurgery, Weifang People's Hospital, Shandong Second Medical University, Weifang, Shandong 261041, P.R. China, Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
    Copyright: © Jiang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 175
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    Published online on: April 24, 2026
       https://doi.org/10.3892/etm.2026.13170
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Abstract

Glomus jugulare tumor (GJT) is a rare paraganglioma arising from neural crest cells. Although the majority of cases are non‑functional, a minority of GJTs can secrete catecholamines. Such functional variants are frequently overlooked due to their rarity and may trigger perioperative crises. The present report documents a 53‑year‑old female patient with a giant occult secretory GJT (65 mm) presenting with prolonged cranial nerve deficits. Preoperative blood pressure was normal, but the patient developed hypertensive crisis (220/130 mmHg) during embolization. Biochemical tests confirmed catecholamine excess. Hemodynamic stability was maintained using calcium channel blockers without α‑blockade after embolization. Tumor resection was performed within 72 h, achieving total resection without intraoperative crisis. Catecholamine levels normalized postoperatively with marked neurological improvement. The present case highlights the importance of recognizing occult secretory GJTs and discusses key management considerations regarding preoperative preparation, timing of surgery and anesthetic management. Increased awareness may improve diagnosis and optimize outcomes in these challenging cases.
View Figures

Figure 1

Preoperative neuroimaging and
endovascular evaluation. (A) T2-weighted and contrast-enhanced
T1-weighted MRI demonstrating a dumbbell-shaped tumor centered in
the left jugular foramen, with intracranial extension compressing
the brainstem and cerebellar hemisphere. (B) CT images in bone and
brain windows showing erosive destruction of the left jugular
foramen and partial involvement of the carotid canal. (C) DSA
illustrating the arterial supply and venous drainage of the tumor,
followed by post-embolization DSA after transcatheter arterial
embolization, which shows a marked reduction in tumor vascularity.
The red ellipses indicate the anatomical location of the tumor on
(B) MRI and its angiographic appearance on (C) angiography. DSA,
digital subtraction angiography; LECA, left external carotid
artery; LICA, left internal carotid artery; LVA, left vertebral
artery; TAE, transarterial embolization.

Figure 2

Perioperative management and outcomes.
(A) Anesthesia record during endovascular embolization
demonstrating a hypertensive crisis (peak systolic pressure, 220
mmHg) following contrast administration and particle embolization,
stabilized with nicardipine infusion. The red box indicates the
blood pressure line on the anesthesia record during the
hypertensive crisis, and blue arrow indicates that blood pressure
management was performed during this period. (B) Postoperative
contrast-enhanced T1-weighted MRI showing complete resection of the
jugular foramen mass with brainstem decompression and fat graft
placement. The blue arrows indicate the MRI appearance after tumor
resection. (C) H&E staining revealing a nested and trabecular
architecture of tumor cells separated by abundant thin-walled and
reticulated vascular channels, with focal areas of necrosis. (D)
Blood pressure trends over the first 11 days of hospitalization
(recorded at 8 AM and 6 PM daily). Red boxes indicate the EVT day;
blue boxes indicate the day of surgery. (E) Images of the patient
at 1 month and 1 year postoperatively. DSA, digital subtraction
angiography; ABG, arterial blood gas; EVT, endovascular
treatment.
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Copy and paste a formatted citation
Spandidos Publications style
Jiang S, Pan T, Qu Y, Gu K, Shang G, Lan X, Ning W and Zhang H: Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol. Exp Ther Med 31: 175, 2026.
APA
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X. ... Zhang, H. (2026). Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol. Experimental and Therapeutic Medicine, 31, 175. https://doi.org/10.3892/etm.2026.13170
MLA
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X., Ning, W., Zhang, H."Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol". Experimental and Therapeutic Medicine 31.6 (2026): 175.
Chicago
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X., Ning, W., Zhang, H."Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol". Experimental and Therapeutic Medicine 31, no. 6 (2026): 175. https://doi.org/10.3892/etm.2026.13170
Copy and paste a formatted citation
x
Spandidos Publications style
Jiang S, Pan T, Qu Y, Gu K, Shang G, Lan X, Ning W and Zhang H: Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol. Exp Ther Med 31: 175, 2026.
APA
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X. ... Zhang, H. (2026). Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol. Experimental and Therapeutic Medicine, 31, 175. https://doi.org/10.3892/etm.2026.13170
MLA
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X., Ning, W., Zhang, H."Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol". Experimental and Therapeutic Medicine 31.6 (2026): 175.
Chicago
Jiang, S., Pan, T., Qu, Y., Gu, K., Shang, G., Lan, X., Ning, W., Zhang, H."Hypertensive crisis during embolization unveils occult catecholamine‑secreting glomus jugulare tumor: A case report and management protocol". Experimental and Therapeutic Medicine 31, no. 6 (2026): 175. https://doi.org/10.3892/etm.2026.13170
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