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

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.