Paragangliomas are rare neuroendocrine tumors derived from the sympathetic and parasympathetic portions of the paraganglia, the presence of metastasis is what determines malignancy. We present the case of a 34-year-old man with a carotid body paraganglioma with metastatic involvement of bone, nodes, liver, and lung, who additionally presents with symptomatic tumor hypoglycemia. Given the advanced stage of the disease, he was not a candidate for surgical management, symptomatic management and high-dose steroids were provided to manage hypoglycemia. He died 2 weeks after admission due to liver failure secondary to metastatic involvement at this level.