Phaechromocytomas (paraganglioma) arising in the bladder are rare neoplasms, accounting for less than 0.06% of bladder tumors.' Since the first case of paraganglioma of the urinary bladder reported by Zimmerman et a],' in 1953, more than 100 cases have been reported in the world literature. 3,4,5,6,7,8.9
CASE REPORT
A 19-year-old woman developed labile hypertension at 30 weeks, menstrual age (MA). It was her first pregnancy and had been uncomplicated until 28 weeks when her blood pressure was 140/90 mm Hg. There was no associated edema, hypereflexia, fundal changes, or proteinuria on urinalysis. Treatment was instituted with bed rest; then with methyldopa and hydrallazine her blood pressure stabilized a t 120170 mm Hg with occasional rises to levels up to 180/100 mm Hg.
At 30 weeks, MA, her blood pressure rose to 220/120 mm Hg with associated headache, epigastric discomfort, and vomiting. Again edema, hypereflexia, fundal changes, and proteinuria were absent. There was no sign of end organ damage from hypertension. Height on the fundus was in keeping with menstrual age, and the fetal heart rate was normal. Hydralazine was administered intramuscularly (IMI) (10 mg) and her blood pressure fell to 185195. A further 10 mg IMI led to a fall in blood pressure to 40/0.
Past history revealed a single episode of hypertension noted by her general practitioner at age 17 years. Subsequent recordings were normal. A minor orthopedic procedure with general anaesthesia was tolerated without complication 12 months earlier. History taken retrospectively after surgery revealed that the patient had suf-From the