Can carotid body paraganglioma cause mental health symptoms such as anxiety, panic attacks, insomnia, or mood disturbances?

Can Carotid Body Paraganglioma Cause Mental Health Symptoms?

Carotid body paragangliomas typically do NOT cause mental health symptoms directly, as they are almost always non-functional tumors that do not secrete catecholamines. 1, 2

Understanding the Functional Status of Carotid Body Paragangliomas

Carotid body paragangliomas are parasympathetic-derived tumors that characteristically lack catecholamine secretion in up to 95% of cases. 1 This is the critical distinguishing feature that separates them from sympathetic paragangliomas and pheochromocytomas, which commonly produce catecholamines that can trigger anxiety, panic attacks, and other psychiatric manifestations. 1

Rare Exceptions Where Mental Health Symptoms May Occur

• In exceptional cases (<5%), carotid body paragangliomas may secrete catecholamines (particularly dopamine), which could theoretically produce anxiety, palpitations, and apprehension. 1, 3
• When catecholamine secretion does occur, patients may experience symptoms including anxiety, apprehension, headache, episodic profuse sweating, and palpitations—manifestations of excess catecholamine secretion. 1
• One documented case of a malignant catecholamine-secreting carotid body paraganglioma demonstrated that dopamine synthesis can be increased in these rare malignant variants. 3

Typical Clinical Presentation (Non-Psychiatric)

The vast majority of carotid body paragangliomas present with mass effect symptoms rather than psychiatric or systemic manifestations. 2, 4, 5

Common Presenting Features:

• Painless, slow-growing neck mass at the carotid bifurcation that may evade diagnosis for months to years 4, 5
• Cranial nerve dysfunction (IX, X, XII) causing hoarseness, dysphagia, vertigo, or coughing 2, 4
• Local compression symptoms including neck fullness, pulsatile tinnitus, hearing loss, or referred ear pain 2, 4
• Paresthesia extending from facial region to tongue 2

Clinical Algorithm for Evaluation

When evaluating a patient with a suspected carotid body paraganglioma, the following approach should be taken:

1. Perform 24-hour urinary catecholamine or metanephrine analysis to identify the rare functional tumor 4

   • This is essential despite the low probability, as perioperative catecholamine crisis can be life-threatening if unrecognized 3

2. Assess for hereditary syndromes, as approximately one-third of paragangliomas are hereditary with autosomal-dominant inheritance 1, 2

   • Explore family history for sudden unexplained deaths and multiple endocrine neoplasia type 2 syndromes 1, 2

3. If mental health symptoms are present (anxiety, panic, insomnia, mood disturbances), consider alternative explanations:

   • Psychological response to chronic illness diagnosis, which is well-documented in patients with chronic medical conditions 1
   • Comorbid primary psychiatric disorders, which affect 20-40% of patients with chronic medical conditions 1
   • The rare functional carotid body paraganglioma with catecholamine excess 3

Important Clinical Pitfalls

Do not assume mental health symptoms are caused by the carotid body paraganglioma itself—this is the most common diagnostic error. 1 The parasympathetic origin of these tumors makes catecholamine secretion extremely rare, and psychiatric symptoms are far more likely to represent:

• Psychological distress from living with a rare tumor diagnosis 1
• Anxiety related to potential surgical complications (cranial nerve injury, stroke risk) 4, 6, 5
• Independent psychiatric conditions requiring separate evaluation and treatment 1

If biochemical testing confirms catecholamine excess in a carotid body paraganglioma, perioperative management must include measures to prevent severe hypertension and arrhythmias, similar to pheochromocytoma surgery. 3