Episodic Hypertension With an Adrenal Mass: A Red Herring

A 66-year-old man with symptomatic hypertensive episodes was found to have a 9-mm adrenal mass and elevated metanephrine levels. He was scheduled for an adrenalectomy for suspected pheochromocytoma. Subsequent workup revealed a large bladder mass which was found to be a paraganglioma. There is no consensus on what should be considered the standard management of primary bladder paraganglioma, including surgical technique, assessment of malignancy, and appropriate follow-up, owing to the rarity of the diagnosis.