Key Clinical Message (63
words):
A 70-year-old female with autosomal dominant polycystic kidney disease
(ADPKD) and hypertension developed profound intraoperative hypotension
during bilateral nephrectomy, subsequently attributed to an undiagnosed
peri-renal paraganglioma. This case underscores the importance of
comprehensive preoperative evaluation in ADPKD patients with severe
hypertension. Greater awareness and early detection of rare tumours like
pheochromocytoma or paragangliomas (PPGLs) are essential to improving
surgical outcomes and patient safety.