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Alkundi A, Momoh R. Phaeochromocytoma in a patient with a Birt-Hogg-Dubé syndrome phenotype. BMJ Case Rep 2023; 16:16/3/e252362. [PMID: 36997239 PMCID: PMC10069485 DOI: 10.1136/bcr-2022-252362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
A case of phaeochromocytoma in a female patient in her 50s with phenotypical expressions for the rare Birt-Hogg-Dubé (BHD) syndrome is presented. Whether this is an incidental finding or that there is a composite relationship between these two entities remains to be fully described. Less than 10 cases reporting likely association of BHD syndrome with adrenal tumours have been reported in the literature to date.
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Affiliation(s)
- Alamin Alkundi
- Diabetes and Endocrinology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Rabiu Momoh
- Department of Intensive Care Medicine, William Harvey hospital, Ashford, Kent, UK
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2
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Hereditary and Sporadic Pheochromocytoma: Comparison of Imaging, Clinical, and Laboratory Features. AJR Am J Roentgenol 2022; 219:97-109. [PMID: 35080458 DOI: 10.2214/ajr.21.26918] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND. A considerable fraction of pheochromocytomas initially suspected to be sporadic, whether or not symptomatic, are a result of germline mutations. OBJECTIVE. The purpose of this article is to compare imaging features between hereditary and sporadic pheochromocytomas. METHODS. This retrospective study included 71 patients (39 women, 32 men; median age, 48 years) who underwent adrenal pheochromocytoma resection from January 2002 to October 2021 after preoperative CT or MRI. Two radiologists independently reviewed examinations to assess features of the largest resected pheochromocytoma. Interreader agreement was assessed by prevalence-adjusted bias-adjusted kappa coefficients; a third radiologist resolved discrepancies for further analysis. Genetic testing was used to classify pheochromocytomas as hereditary or sporadic and to classify hereditary pheochromocytomas by germline mutation clusters. Symptoms associated with pheochromocytomas and preoperative biochemical laboratory values were recorded. Groups were compared using Kruskal-Wallis, Fisher exact, and chi-square tests, and false-discovery rate-adjusted p values were computed to account for multiple comparisons. RESULTS. Hereditary pheochromocytoma (n = 32), compared with sporadic pheochromocytoma (n = 39), was associated with younger median age (38 vs 52 years, p = .001) and smaller median size (24 vs 40 mm, p < .001). Interreader agreement for CT and MRI features, expressed as kappa, ranged from 0.44 to 1.00. Hereditary and sporadic pheochromocytoma showed no difference in frequency of calcifications, hemorrhage, cystic change/necrosis, or macroscopic fat on CT, or in frequency of hemorrhage, cystic change/necrosis, macroscopic fat, or microscopic fat on MRI (p > .05). When combining CT and MRI, cystic change/necrosis was observed in 35% of hereditary versus 67% of sporadic pheochromocytomas (p = .10). Hereditary pheochromocytoma, compared with sporadic, had lower frequency of symptoms (31% vs 74%; p = .004) and lower 24-hour urinary normetanephrines (1.1 vs 5.1 times upper limits of normal, p = .006). Among hereditary pheochromocytomas, cystic change/necrosis (when assessable on imaging) was present in 18% and 45% of those with cluster 1 (n = 11) and cluster 2 (n = 21) germ-line mutations, respectively. CONCLUSION. Hereditary pheochromocytomas, compared with sporadic, are detected at a younger age and smaller size, produce lower 24-hour urinary normetanephrines, are less often symptomatic, and may less frequently show cystic change/necrosis. CLINICAL IMPACT. Imaging findings may complement clinical and biochemical features in raising suspicion for a previously unsuspected germline mutation in patients with pheochromocytoma.
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3
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Kokkapuni N, Thieu M, Bana SA, Cherian R, Haberman A. Atypical variant takotsubo cardiomyopathy secondary to pheochromocytoma. Proc AMIA Symp 2022; 35:526-528. [DOI: 10.1080/08998280.2022.2049574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | | | - Sinan Ali Bana
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Reba Cherian
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Amy Haberman
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
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4
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Genetics of Pheochromocytomas and Paragangliomas Determine the Therapeutical Approach. Int J Mol Sci 2022; 23:ijms23031450. [PMID: 35163370 PMCID: PMC8836037 DOI: 10.3390/ijms23031450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Pheochromocytomas and paragangliomas are the most heritable endocrine tumors. In addition to the inherited mutation other driver mutations have also been identified in tumor tissues. All these genetic alterations are clustered in distinct groups which determine the pathomechanisms. Most of these tumors are benign and their surgical removal will resolve patient management. However, 5–15% of them are malignant and therapeutical possibilities for them are limited. This review provides a brief insight about the tumorigenesis associated with pheochromocytomas/paragangliomas in order to present them as potential therapeutical targets.
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Hafiz B, Buksh O, Alammari A, Khogeer A, Alturkistani S, Gomaa W, Al-Maghrabi J. Concurrent Urinary Bladder Paraganglioma and Adrenal Phaeochromocytoma With Succinate Dehydrogenase-B Mutation. Cureus 2021; 13:e17350. [PMID: 34567891 PMCID: PMC8451535 DOI: 10.7759/cureus.17350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
Phaeochromocytoma (PHEO) is a neoplasm that arises from chromaffin cells present in the adrenal medulla. The counterpart of the PHEO extra-adrenal is termed paraganglioma (PGL). The urinary bladder PGL is a rare tumour, and it accounts for less than 0.06% of all bladder tumours. In this report, we discuss a case of a young female who presented with symptoms of headache, dizziness, palpitations, and high blood pressure. After workup, she was diagnosed with concurrent urinary bladder PGL and adrenal PHEO, and the genetic study of the whole exon sequence indicated the presence of succinate dehydrogenase-B (SDHB) mutation. Both tumours were treated surgically; however, the patient ultimately developed recurrence, rapid progression, and metastasis. All secondary modalities were unsuccessful, and the patient was referred for palliative treatment and eventually lost to follow-up. PGL should be included in the differential diagnosis of bladder tumours, and testing for SDHB gene mutations should be considered in all urinary PGLs. Therefore, these patients need follow-up and genetic counselling.
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Affiliation(s)
- Bayan Hafiz
- Department of Anatomic Pathology, King Abdulaziz Medical City, Jeddah, SAU
| | - Omar Buksh
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Adel Alammari
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Ahmed Khogeer
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Samirah Alturkistani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Wafaey Gomaa
- Department of Pathology, Faculty of Medicine - King Abdulaziz University, Jeddah, SAU.,Department of Pathology, Faculty of Medicine - Minia University, Al Minia, EGY
| | - Jaudah Al-Maghrabi
- Department of Pathology, Faculty of Medicine - King Abdulaziz University, Jeddah, SAU
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Wani A, Adil A, Gardezi SAA, Jain R, Galazka P, Waples MJ, Tajik AJ. Pheochromocytoma Presenting as Hypertrophic Obstructive Cardiomyopathy. JAMA Cardiol 2021; 6:974-976. [PMID: 33978674 DOI: 10.1001/jamacardio.2021.0944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adil Wani
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - Amina Adil
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - Syed Ali A Gardezi
- Department of Endocrinology, Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - Mark J Waples
- Department of Urology, Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
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Concepción Zavaleta MJ, Armas Flórez CD, Benites Moya CJ, Plasencia Dueñas EA, Ildefonso Najarro SP, Palomino Taype K, Durand Torres R, Massucco Revoredo F. Surgical Remission of Diabetes in a Patient With Mutation of RET Proto-Oncogene. AACE Clin Case Rep 2021; 7:256-260. [PMID: 34307848 PMCID: PMC8282531 DOI: 10.1016/j.aace.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In pheochromocytomas, accelerated catecholamine production can cause secondary diabetes. The gene responsible for multiple endocrine neoplasia type 2 (MEN2)-related pheochromocytomas is the RET proto-oncogene. The objective of this report is to describe a unique case of surgical remission of misdiagnosed type 2 diabetes mellitus (T2DM) in a woman with bilateral pheochromocytoma and RET proto-oncogene mutation. METHODS Clinical examination, urinary metanephrine level, triple-phase abdominal computed tomography (CT) with adrenal protocol, positron emission tomography with 18F-fluorodeoxyglucose integrated with CT, surgical pathology, and genetic testing were performed. RESULTS A 46-year-old woman with a 5-year history of apparent T2DM complicated by neuropathy, without a contributory family history, presented with occasional headaches, weight loss, and abdominal pain. A 24-hour urinary metanephrine of 5 mg (reference range, 0.05-1 mg) was found. Abdominal CT showed bilateral adrenal masses with <60% washout. Positron emission tomography with 18F-fluorodeoxyglucose integrated with CT showed a left solid-cystic lesion with low metabolic activity and a right nodular lesion with a higher metabolic activity, which was conclusive of bilateral pheochromocytoma. The remission of diabetes was achieved 1 year after a bilateral adrenalectomy. In addition, a multinodular goiter was found, and a fine-needle aspiration biopsy confirmed that it was a medullary thyroid carcinoma. A heterozygous pathogenic variant of the RET proto-oncogene was found and MEN2A was confirmed. CONCLUSION This is the first report of a patient with a RET proto-oncogene mutation experiencing remission of diabetes after surgical resection of bilateral pheochromocytomas. Timely recognition and treatment of the underlying condition are important to potentially achieve diabetes remission and prevent its long-term complications.
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Affiliation(s)
| | - Cristian David Armas Flórez
- School of Medicine, Universidad Nacional de Trujillo, Trujillo, Peru
- Address correspondence and reprint requests to Dr Cristian David Armas Flórez, School of Medicine, Universidad Nacional de Trujillo. Av. Roma 338, Trujillo, 13011 Peru.
| | | | | | | | - Kely Palomino Taype
- Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Ricardo Durand Torres
- Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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8
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Cruz-Flores S. Neurological Complications of Endocrine Emergencies. Curr Neurol Neurosci Rep 2021; 21:21. [PMID: 33709163 DOI: 10.1007/s11910-021-01105-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Endocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the systemic effect of hormones across many organs and systems including the nervous system. This is a narrative review of the recent evidence of the diagnosis and treatment approach of these medical and neurological emergencies. RECENT FINDINGS With the possible exception of diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia, endocrinological emergencies are complex, uncommon yet life-threatening conditions with protean and often nonspecific early clinical signs. They frequently are the first manifestation of the endocrine derangement. The systemic effects of hormones extend to the nervous system and as such, these conditions can present with neurological complications manifested, in most cases, by a diffuse dysfunction of the brain in the form of encephalopathy, delirium, seizures, and coma; or specific and peculiar syndromes such as hemichorea, hemiballism, and epilepsia partialis continua. The severity of these conditions often necessitates management in the intensive care unit requiring substantial supportive care in addition to specific targeted therapy to correct the hormonal metabolic abnormalities while at the same time blocking hormonal activity, in cases of excessive function, or supplementing hormonal deficiencies. Endocrine emergencies and their neurological complications are infrequent. The major challenge for most is early recognition. Their morbidity and mortality are high and their diagnosis requires high index of suspicion. The neurological complication most often improves with the correction of the metabolic derangement and their acuity and severity require admission to the intensive care unit.
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Affiliation(s)
- Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
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9
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Falcetta P, Orsolini F, Molinaro E, Vitti P, Tonacchera M. Tako-tsubo Syndrome as First Manifestation in a Case of Pheochromocytoma Developed From a Non-functional Adrenal Incidentaloma. Front Endocrinol (Lausanne) 2020; 11:51. [PMID: 32117073 PMCID: PMC7033429 DOI: 10.3389/fendo.2020.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Pheochromocytoma is a catecholamine secreting tumor that, in extremely rare cases, may develop over time from a non-functional adrenal adenoma. Catecholamine excess can lead to a kind of cardiomyopathy similar to that seen in tako-tsubo syndrome (TTS). Case report: A 69 years old female with a history of type 2 diabetes, hypertension, and a non-functional right adrenal adenoma diagnosed 3 years earlier was referred to our center for further investigations. During the evaluation, she had a hypertensive crisis with chest pain, tachycardia, and diaphoresis. Suspecting an acute coronary syndrome, she underwent coronary angiography, which showed the typical features of TTS. The high 24 h-urinary metanephrines excretion and abdominal MRI findings were suggestive of pheochromocytoma. Right laparoscopic adrenalectomy was performed, with the resolution of all symptoms. Pathology findings confirmed the diagnosis of pheochromocytoma. After 12 months, the patient was still asymptomatic, with the echocardiography displaying a complete recovery of the left-ventricular function. Conclusions: The development of a pheochromocytoma from an adrenal non functional adenoma is an extremely rare event, but potentially life-threating because of the catecholamine-associated cardiovascular toxicity. In particular, TTS is a form of cardiomyopathy that has been increasingly described as associated with catecholamine-secreting tumors. The exclusion of pheochromocytoma in a patient with TTS has important therapeutic implications, since the administration of β-blockers may be extremely harmful in patients with catecholamine surge in the absence of adequate α-blockage.
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10
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Guha A, Musil Z, Vícha A, Zelinka T, Pacák K, Astl J, Chovanec M. A systematic review on the genetic analysis of paragangliomas: primarily focused on head and neck paragangliomas. Neoplasma 2019; 66:671-680. [PMID: 31307198 PMCID: PMC6826254 DOI: 10.4149/neo_2018_181208n933] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/06/2019] [Indexed: 12/20/2022]
Abstract
Head and neck paragangliomas Paragangliomas and pheochromocytomas are rare, mostly benign neuroendocrine tumors, which are embryologically derived from neural crest cells of the autonomic nervous system. Paragangliomas are essentially the extra-adrenal counterparts of pheochromocytomas. As such this family of tumors can be subdivided into head and neck paragangliomas, pheochromocytomas and thoracic and abdominal extra-adrenal paragangliomas. Ten out of fifteen genes that contribute to the development of paragangliomas are more susceptible to the development of head and neck paragangliomas when mutated. Gene expression profiling revealed that pheochromocytomas and paragangliomas can be classified into two main clusters (C1 and C2) based on transcriptomes. These groups were defined according to their mutational status and as such strongly associated with specific tumorigenic pathways. The influence of the main genetic drivers on the somatic molecular phenotype was shown by DNA methylation and miRNA profiling. Certain subunits of succinate dehydrogenase (SDHx), von Hippel-Lindau (VHL) and transmembrane protein 127 (TMEM127) still have the highest impact on development of head and neck paragangliomas. The link between RAS proteins and the formation of pheochromocytoma and paragangliomas is clear due to the effect of receptor tyrosine-protein kinase (RET) and neurofibromatosis type 1 (NF1) in RAS signaling and recent discovery of the role of HRAS. The functions of MYC-associated factor X (MAX) and prolyl hydroxylase 2 (PHD2) mutations in the contribution to the pathogenesis of paragangliomas still remain unclear. Ongoing studies give us insight into the incidence of germline and somatic mutations, thus offering guidelines to early detection. Furthermore, these also show the risk of mistakenly assuming sporadic cases in the absence of definitive family history in head and neck paragangliomas.
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Affiliation(s)
- Anasuya Guha
- Department of Otorhinolaryngology, 3 Faculty of Medicine and University Hospital Kralovske Vinohrady, Charles University in Prague, Czech Republic
| | - Zdenek Musil
- Department of Biology and Medical Genetics, 1 Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic
| | - Aleš Vícha
- Department of Pediatric Hematology and Oncology, 2 Faculty of Medicine and University Hospital Motol, Charles University in Prague, Czech Republic
| | - Tomáš Zelinka
- Department of Endocrinology and Metabolism, 1 Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic
| | - Karel Pacák
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jaromir Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, 3 Faculty of Medicine and Military University Hospital, Charles University in Prague, Czech Republic
| | - Martin Chovanec
- Department of Otorhinolaryngology, 3 Faculty of Medicine and University Hospital Kralovske Vinohrady, Charles University in Prague, Czech Republic
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11
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Sivaskandarajah GA, Arnason TG. Unsuspected Von Hippel-Lindau syndrome in acute-onset resistant hypertension. BMJ Case Rep 2018; 2018:bcr-2018-225162. [PMID: 30042107 DOI: 10.1136/bcr-2018-225162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The discovery of adrenal lesions during routine testing for hypertension requires focused consideration for adrenal overproduction of cortisol, aldosterone or metanephrines. An otherwise healthy 25-year-old woman presented with headaches, diaphoresis and hot flushes with grossly elevated urine catecholamines, normetanephrines and norepinephrine levels, yet normal metanephrines, epinephrine/epinephrine, cortisol and aldosterone levels. Subsequent functional uptake studies and scans identified bilateral adrenal adenomas consistent with phaeochromocytomas. There was no family history of phaeochromocytomas or familial syndromes; however, a targeted genetic analysis for causes of familial phaeochromocytomas identified a heterozygous germline mutation in the VHL gene consistent with Von Hippel-Lindau syndrome. In this case, the identification of the VHL mutation led to careful screening and detection of clinically occult central nervous system hemangioblastomas and pancreatic neuroendocrine tumours. Verified genetic mutations facilitated best practices for long-term surveillance protocols, preconception counselling and screening of blood relatives. The patient responded well to surgical treatment and has ongoing multidisciplinary long-term surveillance.
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Affiliation(s)
| | - Terra G Arnason
- Department of Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
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12
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Neurocristopathies: New insights 150 years after the neural crest discovery. Dev Biol 2018; 444 Suppl 1:S110-S143. [PMID: 29802835 DOI: 10.1016/j.ydbio.2018.05.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022]
Abstract
The neural crest (NC) is a transient, multipotent and migratory cell population that generates an astonishingly diverse array of cell types during vertebrate development. These cells, which originate from the ectoderm in a region lateral to the neural plate in the neural fold, give rise to neurons, glia, melanocytes, chondrocytes, smooth muscle cells, odontoblasts and neuroendocrine cells, among others. Neurocristopathies (NCP) are a class of pathologies occurring in vertebrates, especially in humans that result from the abnormal specification, migration, differentiation or death of neural crest cells during embryonic development. Various pigment, skin, thyroid and hearing disorders, craniofacial and heart abnormalities, malfunctions of the digestive tract and tumors can also be considered as neurocristopathies. In this review we revisit the current classification and propose a new way to classify NCP based on the embryonic origin of the affected tissues, on recent findings regarding the molecular mechanisms that drive NC formation, and on the increased complexity of current molecular embryology techniques.
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13
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Wasserman JD, Tomlinson GE, Druker H, Kamihara J, Kohlmann WK, Kratz CP, Nathanson KL, Pajtler KW, Parareda A, Rednam SP, States LJ, Villani A, Walsh MF, Zelley K, Schiffman JD. Multiple Endocrine Neoplasia and Hyperparathyroid-Jaw Tumor Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood. Clin Cancer Res 2018; 23:e123-e132. [PMID: 28674121 DOI: 10.1158/1078-0432.ccr-17-0548] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/02/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Abstract
Children and adolescents who present with neuroendocrine tumors are at extremely high likelihood of having an underlying germline predisposition for the multiple endocrine neoplasia (MEN) syndromes, including MEN1, MEN2A and MEN2B, MEN4, and hyperparathyroid-jaw tumor (HPT-JT) syndromes. Each of these autosomal dominant syndromes results from a specific germline mutation in unique genes: MEN1 is due to pathogenic MEN1 variants (11q13), MEN2A and MEN2B are due to pathogenic RET variants (10q11.21), MEN4 is due to pathogenic CDKN1B variants (12p13.1), and the HPT-JT syndrome is due to pathogenic CDC73 variants (1q25). Although each of these genetic syndromes share the presence of neuroendocrine tumors, each syndrome has a slightly different tumor spectrum with specific surveillance recommendations based upon tumor penetrance, including the age and location for which specific tumor types most commonly present. Although the recommended surveillance strategies for each syndrome contain similar approaches, important differences do exist among them. Therefore, it is important for caregivers of children and adolescents with these syndromes to become familiar with the unique diagnostic criteria for each syndrome, and also to be aware of the specific tumor screening and prophylactic surgery recommendations for each syndrome. Clin Cancer Res; 23(13); e123-e32. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Gail E Tomlinson
- Department of Pediatrics, Division of Hematology and Oncology and Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Harriet Druker
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Junne Kamihara
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wendy K Kohlmann
- Huntsmann Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Katherine L Nathanson
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristian W Pajtler
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreu Parareda
- Division of Oncology, Predisposition and Survivorship Units, Sant Joan de Déu - Barcelona Children's Hospital, Barcelona, Spain
| | - Surya P Rednam
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anita Villani
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael F Walsh
- Departments of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kristin Zelley
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua D Schiffman
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Kadiyala S, Khan Y, de Miguel V, Frone MN, Nwariaku F, Rabaglia J, Woodruff S, King EE, Hathiramani SS, Pacak K, Ghayee HK. SDHD Gene Mutations: Looking Beyond Head and Neck Tumors. AACE Clin Case Rep 2018. [DOI: 10.4158/ep172003.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Čtvrtlík F, Koranda P, Schovánek J, Škarda J, Hartmann I, Tüdös Z. Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy. Exp Ther Med 2018; 15:3151-3160. [PMID: 29545830 PMCID: PMC5840941 DOI: 10.3892/etm.2018.5871] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
The topic of pheochromocytomas is becoming increasingly popular as a result of major advances in different medical fields, including laboratory diagnosis, genetics, therapy, and particularly in novel advances in imaging techniques. The present review article discusses current clinical, biochemical, genetic and histopathological aspects of the diagnosis of pheochromocytomas and planning of pre-surgical preparation and subsequent surgical treatment options. The main part of the paper is focused on the role of morphological imaging methods (primarily computed tomography and magnetic resonance imaging) and functional imaging (scintigraphy and positron emission tomography) in the diagnosis and staging of pheochromocytomas.
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Affiliation(s)
- Filip Čtvrtlík
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Pavel Koranda
- Department of Nuclear Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Jan Schovánek
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Jozef Škarda
- Department of Clinical and Molecular Pathology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Zbyněk Tüdös
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
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16
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Dias Pereira B, Nunes da Silva T, Bernardo AT, César R, Vara Luiz H, Pacak K, Mota-Vieira L. A Clinical Roadmap to Investigate the Genetic Basis of Pediatric Pheochromocytoma: Which Genes Should Physicians Think About? Int J Endocrinol 2018; 2018:8470642. [PMID: 29755524 PMCID: PMC5884154 DOI: 10.1155/2018/8470642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/18/2018] [Indexed: 01/06/2023] Open
Abstract
Pheochromocytoma is very rare at a pediatric age, and when it is present, the probability of a causative genetic mutation is high. Due to high costs of genetic surveys and an increasing number of genes associated with pheochromocytoma, a sequential genetic analysis driven by clinical and biochemical phenotypes is advised. The published literature regarding the genetic landscape of pediatric pheochromocytoma is scarce, which may hinder the establishment of genotype-phenotype correlations and the selection of appropriate genetic testing at this population. In the present review, we focus on the clinical phenotypes of pediatric patients with pheochromocytoma in an attempt to contribute to an optimized genetic testing in this clinical context. We describe epidemiological data on the prevalence of pheochromocytoma susceptibility genes, including new genes that are expanding the genetic etiology of this neuroendocrine tumor in pediatric patients. The clinical phenotypes associated with a higher pretest probability for hereditary pheochromocytoma are presented, focusing on differences between pediatric and adult patients. We also describe new syndromes, as well as rates of malignancy and multifocal disease associated with these syndromes and pheochromocytoma susceptibility genes published more recently. Finally, we discuss new tools for genetic screening of patients with pheochromocytoma, with an emphasis on its applicability in a pediatric population.
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Affiliation(s)
- Bernardo Dias Pereira
- Serviço de Endocrinologia e Nutrição, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Tiago Nunes da Silva
- Serviço de Endocrinologia e Diabetes, Hospital Garcia de Orta (EPE), Av. Torrado da Silva, 2851-951 Almada, Setúbal, Portugal
| | - Ana Teresa Bernardo
- Serviço de Cirurgia Geral, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Rui César
- Serviço de Endocrinologia e Nutrição, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Henrique Vara Luiz
- Serviço de Endocrinologia e Diabetes, Hospital Garcia de Orta (EPE), Av. Torrado da Silva, 2851-951 Almada, Setúbal, Portugal
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver NICHD, NIH, Building 10 CRC 1E-3140 10 Center Drive MSC-1109, Bethesda, MD 20892-1109, USA
| | - Luísa Mota-Vieira
- Unidade de Genética e Patologia Moleculares, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
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17
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Kavinga Gunawardane PT, Grossman A. The clinical genetics of phaeochromocytoma and paraganglioma. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:490-500. [PMID: 29166454 PMCID: PMC10522248 DOI: 10.1590/2359-3997000000299] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 11/22/2022]
Abstract
Phaeochromocytoma and paraganglioma are rare catecholamine-producing tumours, recognised to have one of the richest hereditary backgrounds of all neoplasms, with germline mutations seen in approximately 30% of patients. They can be a part of genetic syndromes such as MEN 2 or Neurofibromatosis type 1, or can be found as apparently sporadic tumours. Germline mutations are almost always found in syndromic patients. Nonetheless, apparently sporadic phaeochromocytoma too show high germline mutation rates. Early detection of a genetic mutation can lead to early diagnosis of further tumours via surveillance, early treatment and better prognosis. Apart from this, the genetic profile has important relevance for tumour location and biochemical profile, and can be a useful predictor of future tumour behaviour. It also enables family screening and surveillance. Moreover, recent studies have demonstrated significant driver somatic mutations in up to 75% of all tumours. Arch Endocrinol Metab. 2017;61(5):490-500.
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Affiliation(s)
- P. T. Kavinga Gunawardane
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordUKOxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
| | - Ashley Grossman
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordUKOxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
- Green Templeton CollegeUniversity of OxfordUKGreen Templeton College, University of Oxford, UK
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18
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Campos-Fernández J, Aguillo-Gutiérrez E, Agudo-Tabuenca A, Medrano-Navarro AL, Borau-Maorad L. Abdominal pain and hipertensive crisis as initial manifestation of a malignant pheocromocytoma. ACTA ACUST UNITED AC 2017; 64:178-180. [PMID: 28440758 DOI: 10.1016/j.endinu.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Julia Campos-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | - Ana Agudo-Tabuenca
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Ana Lidia Medrano-Navarro
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Laura Borau-Maorad
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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19
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Khatami F, Tavangar SM. Current Diagnostic Status of Pheochromocytomaand Future Perspective: A Mini Review. IRANIAN JOURNAL OF PATHOLOGY 2017; 12. [PMID: 29531562 PMCID: PMC5835385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pheochromocytomas (PCCs) are rare neuroendocrine tumors. The current diagnostic tools are based on biochemistry and histopathology results, but heterogeneity of diagnostic markers, signs and symptoms of PCCs bring a lot of difficulties for these two current methods. Unfortunately, microscopic understanding of PCCs is not adequate for its confident prognosis and management. There are data linking specific genotypes of PCCs tumors to specific locations, typical biochemical phenotypes or future clinical behaviors. The detection of a germ-line mutation possibly can guide us to an early diagnosis, appropriate treatment, and regular surveillance with better prognosis for patients but also and their family members. Moreover, the latest discoveries in gene sequencing, circulating DNA (ctDNA) and circulating tumor cells (CTCs) will support the exact molecular pathogenesis of PCCs to provide an important basis for future PCCs managements.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Dept. of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Information: Dr. Seyed Mohammad Tavangar, Dept. of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98 21 84902187, Fax: +98 21 88633078, E-mail address:
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20
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Violante AHD, Ortiga-Carvalho TM, Soares da Costa MH, Vaisman M. Treatment of pheochromocytomas and paragangliomas: genetic approach? INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2016-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are neuroendocrine tumors derived from the chromaffin tissue of the adrenal medulla or from extra-adrenal sympathetic and parasympathetic paraganglia. These tumors affect one in 2500–6500 people, with 500–1600 patients diagnosed annually in the USA. Its real incidence is likely to be much higher, and many patients may die undiagnosed. It is a rare cause of secondary hypertension, with an incidence of 0.1–0.6%. PHEOs are more common than PGLs, and 5–7% is related to hormonal secretion. The average age of diagnosis is 43 years, but 10–20% of PHEO/PGL patients are children, and the tumors are generally associated with genetic conditions. The worldwide consensus is that people with PHEOs/PGLs should undergo a mandatory genetic investigation, especially with multiple injuries and those who are younger. Although many PHEOs are sporadic and benign, approximately 30% of familial tumor cases have been identified. Multiple endocrine neoplasia type 2, von Hippel–Lindau syndrome and neurofibromatosis type 1 are classically linked to PHEO and mutations in succinate dehydrogenase complex subunits have been associated with familial forms. Our goal is to review various clinical syndromes in which PHEOs/PGLs are present, along with their therapeutic options.
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Affiliation(s)
| | - Tania M Ortiga-Carvalho
- Laboratory of Translational Endocrinology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mario Vaisman
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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21
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Chang CA, Pattison DA, Tothill RW, Kong G, Akhurst TJ, Hicks RJ, Hofman MS. (68)Ga-DOTATATE and (18)F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity. Cancer Imaging 2016; 16:22. [PMID: 27535829 PMCID: PMC4989291 DOI: 10.1186/s40644-016-0084-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 12/24/2022] Open
Abstract
Background Pheochromocytomas (PCC) and paragangliomas (PGL) are neuroendocrine tumours arising from pluripotent neural crest stem cells and are associated with neurons of the autonomic nervous system. PCCs/PGLs are often hereditary and multifocal, and their biologic behaviour and metabolic activity vary making imaging of these tumours challenging. The imaging gold standard has been I-123 MIBG complemented by CT or MRI. PGLs being neuroendocrine tumours express somatostatin receptors enabling imaging with Ga-68 DOTA-coupled peptides such as DOTATATE. Imaging with F-18 FDG also provides additional information regarding metabolic activity and biologic aggressiveness of these tumours, or, in some situations, reflecting metabolic reprogramming of these tumours. We report our experience using both Ga-68 DOTATATE and F-18 FDG PET/CT imaging in patients with PGLs and PCCs. Methods This was a retrospective review of 23 patients with proven PGL/PCC who underwent both DOTATATE and FDG PET/CT. Seven patients also had I-123 MIBG SPECT/CT and 1 patient had I-124 MIBG PET/CT. Lesional intensity and patterns of uptake were analysed. Results DOTATATE and FDG were positive at most sites of disease (96.2 % vs 91.4 %), although uptake intensity was significantly higher on DOTATATE with a median SUV of 21 compared to 12.5 for FDG (p < 0.001). SUVmax on F-18 FDG was significantly higher (p < 0.001) in clinically aggressive cases. I-123/I-124 MIBG detected fewer lesions (30.4 %). Conclusion Overall, Ga-68 DOTATATE PET/CT detected similar number but has significantly greater lesion-to-background contrast compared to F-18 FDG PET/CT. Combined with high specificity, patient convenience and relatively low cost, DOTATATE PET/CT should be considered the ideal first line investigation for imaging PGL/PCC. Depending on DOTATATE findings and the clinical question, FDG and MIBG remain useful and, in selected cases, may provide more accurate staging, disease characterisation and guide treatment choices.
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Affiliation(s)
- Chian A Chang
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - David A Pattison
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Endocrinology Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Richard W Tothill
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Grace Kong
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tim J Akhurst
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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22
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Abstract
About 30% of phaeochromocytomas or paragangliomas are genetic. Whilst some individuals will have clinical features or a family history of inherited cancer syndrome such as neurofibromatosis type 1 (NF1) or multiple endocrine neoplasia 2 (MEN2), the majority will present as an isolated case. To date, 14 genes have been described in which pathogenic mutations have been demonstrated to cause paraganglioma or phaeochromocytoma . Many cases with a pathogenic mutation may be at risk of developing further tumours. Therefore, identification of genetic cases is important in the long-term management of these individuals, ensuring that they are entered into a surveillance programme. Mutation testing also facilitates cascade testing within the family, allowing identification of other at-risk individuals. Many algorithms have been described to facilitate cost-effective genetic testing sequentially of these genes, with phenotypically driven pathways. New genetic technologies including next-generation sequencing and whole-exome sequencing will allow much quicker, cheaper and extensive testing of individuals in whom a genetic aetiology is suspected.
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23
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Minnetti M, Grossman A. Somatic and germline mutations in NETs: Implications for their diagnosis and management. Best Pract Res Clin Endocrinol Metab 2016; 30:115-27. [PMID: 26971848 DOI: 10.1016/j.beem.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
It is now understood that specific somatic and germline mutations may lead to the development of the neuroendocrine tumours (NETs). NETs usually occur as sporadic isolated tumours, although they also may present as part of complex familial endocrine cancer syndromes, such as multiple endocrine neoplasia type 1 (MEN1) and type 2 (MEN2), Von Hippel-Lindau (VHL) and neurofibromatosis syndromes, tuberous sclerosis, Carney triad and dyad, Reed syndrome and polycythaemia-paraganglioma syndromes. Only in MEN2 syndrome is there a specific genotype-phenotype correlation, although in both sporadic and syndromic NETs some gene mutations are associated with specific clinico-pathological features and prognosis. There have been several advances in our understanding of the NETs leading to earlier detection and targeted therapeutic treatment, but given the poor prognosis associated with metastatic NETs, it will be necessary to find new biomarkers for the prediction of malignant potential and to find novel therapeutic targets for NETs.
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Affiliation(s)
- Marianna Minnetti
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK
| | - Ashley Grossman
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK.
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24
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Schovanek J, Bullova P, Tayem Y, Giubellino A, Wesley R, Lendvai N, Nölting S, Kopacek J, Frysak Z, Pommier Y, Kummar S, Pacak K. Inhibitory Effect of the Noncamptothecin Topoisomerase I Inhibitor LMP-400 on Female Mice Models and Human Pheochromocytoma Cells. Endocrinology 2015; 156:4094-104. [PMID: 26267380 PMCID: PMC4606751 DOI: 10.1210/en.2015-1476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metastatic pheochromocytoma continues to be an incurable disease, and treatment with conventional cytotoxic chemotherapy offers limited efficacy. In the present study, we evaluated a novel topoisomerase I inhibitor, LMP-400, as a potential treatment for this devastating disease. We found a high expression of topoisomerase I in human metastatic pheochromocytoma, providing a basis for the evaluation of a topoisomerase 1 inhibitor as a therapeutic strategy. LMP-400 inhibited the cell growth of established mouse pheochromocytoma cell lines and primary human tumor tissue cultures. In a study performed in athymic female mice, LMP-400 demonstrated a significant inhibitory effect on tumor growth with two drug administration regimens. Furthermore, low doses of LMP-400 decreased the protein levels of hypoxia-inducible factor 1 (HIF-1α), one of a family of factors studied as potential metastatic drivers in these tumors. The HIF-1α decrease resulted in changes in the mRNA levels of HIF-1 transcriptional targets. In vitro, LMP-400 showed an increase in the growth-inhibitory effects in combination with other chemotherapeutic drugs that are currently used for the treatment of pheochromocytoma. We conclude that LMP-400 has promising antitumor activity in preclinical models of metastatic pheochromocytoma and its use should be considered in future clinical trials.
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MESH Headings
- Adrenal Gland Neoplasms/drug therapy
- Adrenal Gland Neoplasms/enzymology
- Adrenal Gland Neoplasms/pathology
- Animals
- Antineoplastic Agents/pharmacology
- Benzodioxoles/administration & dosage
- Benzodioxoles/pharmacology
- Blotting, Western
- Cell Hypoxia
- Cell Line, Tumor
- Cell Proliferation/drug effects
- DNA Topoisomerases, Type I/metabolism
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Drug Synergism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Isoquinolines/administration & dosage
- Isoquinolines/pharmacology
- Liver Neoplasms/drug therapy
- Liver Neoplasms/enzymology
- Liver Neoplasms/secondary
- Lung Neoplasms/drug therapy
- Lung Neoplasms/enzymology
- Lung Neoplasms/secondary
- Mice, Nude
- PC12 Cells
- Pheochromocytoma/drug therapy
- Pheochromocytoma/enzymology
- Pheochromocytoma/pathology
- Rats
- Reverse Transcriptase Polymerase Chain Reaction
- Topoisomerase I Inhibitors/administration & dosage
- Topoisomerase I Inhibitors/pharmacology
- Tumor Cells, Cultured
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Affiliation(s)
- Jan Schovanek
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Petra Bullova
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Yasin Tayem
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Alessio Giubellino
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Robert Wesley
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Nikoletta Lendvai
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Svenja Nölting
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Juraj Kopacek
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Zdenek Frysak
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Yves Pommier
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Shivaani Kummar
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
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Affiliation(s)
- Hans K Ghayee
- University of Florida College of Medicine, Gainesville, Florida 32603
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Jochmanová I, Zelinka T, Widimský J, Pacak K. HIF signaling pathway in pheochromocytoma and other neuroendocrine tumors. Physiol Res 2015; 63:S251-62. [PMID: 24908231 DOI: 10.33549/physiolres.932789] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Hypoxia-inducible factors (HIFs) are transcription factors controlling energy, iron metabolism, erythropoiesis, and development. Dysregulation of these proteins contributes to tumorigenesis and cancer progression. Recent findings revealed the important role of HIFs in the pathogenesis of neuroendocrine tumors, especially pheochromocytoma (PHEO) and paraganglioma (PGL). PHEOs and PGLs are catecholamine-producing tumors arising from sympathetic- or parasympathetic-derived chromaffin tissue. To date, eighteen PHEO/PGL susceptibility genes have been identified. Based on the main signaling pathways, PHEOs/PGLs have been divided into two clusters, pseudohypoxic cluster 1 and cluster 2, rich in kinase receptor signaling and protein translation pathways. Recent data suggest that both clusters are interconnected via the HIF signaling and its role in tumorigenesis is supported by newly described somatic and germline mutations in HIF2A gene in patients with PHEOs/PGLs associated with polycythemia, and in some of them also with somatostatinoma. Moreover, HIFalpha signaling has also been shown to be upregulated in neuroendocrine tumors other than PHEO/PGL. Some of these tumors are components of hereditary tumor syndromes which can be associated with PHEO/PGL, but also in ileal carcinoids or melanoma. HIF signaling appears to be one of the crucial players in tumorigenesis, which could suggest new therapeutic approaches for treatment of neuroendocrine tumors.
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Affiliation(s)
- I Jochmanová
- Department of Internal Medicine, Faculty of Medicine, P. J. Šafárik University, Košice, Slovakia; Section on Medical Neuroendocrinology, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, NIH, Bethesda, MD, USA.
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Perry CG, Freel EM, O'Dwyer P, Schiffrin EL, Jennings GL, Dominiczak AF, De Buyzere M. Rare cause of severe hypertension in a young woman. Hypertension 2014; 65:21-4. [PMID: 25385763 DOI: 10.1161/hypertensionaha.114.04619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Colin G Perry
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.).
| | - E Marie Freel
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
| | - Patrick O'Dwyer
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
| | - Ernesto L Schiffrin
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
| | - Garry L Jennings
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
| | - Anna F Dominiczak
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
| | - Marc De Buyzere
- From the Institute of Cardiovascular and Medical Sciences (E.M.F., A.F.D.) and School of Medicine (C.G.P., P.O'D.), University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ, Canada (E.L.S.); Director's Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.J.); and Department of Cardiology, Ghent University, Ghent, Belgium (M.D.B.)
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Luft FC. Preparation for hypertension specialists: genomics reveals the pathogenesis of hypertension. ACTA ACUST UNITED AC 2014; 8:607-11. [PMID: 25151324 DOI: 10.1016/j.jash.2014.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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The size of the primary tumor and age at initial diagnosis are independent predictors of the metastatic behavior and survival of patients with SDHB-related pheochromocytoma and paraganglioma: a retrospective cohort study. BMC Cancer 2014; 14:523. [PMID: 25048685 PMCID: PMC4223758 DOI: 10.1186/1471-2407-14-523] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background Succinate dehydrogenase subunit B (SDHB) mutations are associated with aggressive pheochromocytoma (PHEO)/paraganglioma (PGL) behavior, often resulting in metastatic disease and fatal outcomes. These tumors are often larger, extra-adrenal, and contain lower catecholamine concentrations than other hereditary PHEOs/PGLs. This study evaluated the size and age at diagnosis of primary SDHB-related PHEOs/PGLs as independent predictors of their metastatic behavior and outcome (survival). Methods One hundred six patients with SDHB mutation-related PHEO/PGL were included in this retrospective study. The recorded largest diameters, locations, and patient ages at initial diagnosis of SDHB-related primary tumors were analyzed in the context of time to metastasis and patient survival. Results First, the development of metastatic disease in patients with primary tumors ≥4.5 cm was significantly earlier than in patients with smaller tumors (P = 0.003). Second, patients with primary tumors larger than 5.5 cm also had worse overall survival than patients with smaller tumors (P = 0.008). Third, age at initial diagnosis was found to be an independent predictor of patient survival (PHEOs: P = 0.041; PGLs: P < 0.001). Fourth, we did not observe a significant difference in survival based on the specific SDHB mutations or patient sex. Conclusion Receiver operating characteristic curves established 4.5 cm as the best value to dichotomize the primary SDHB-related PHEO/PGL in order to evaluate the development of metastatic disease and 5.5 cm as the best value for survival prediction. Subsequently, the size of the primary tumor was found as an age-independent predictor of patient survival and metastases development in PGL. In both PHEO and PGL, age at diagnosis was found to be a size-independent predictor of patient survival. No significant difference was found in metastases development or patient survival between males and females or among specific SDHB mutations. This data further extends and supports previous recommendations that carriers with SDHB mutations must undergo early and regular evaluations to detect PHEO/PGL in order to achieve the best clinical outcome.
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Abstract
Pheochromocytomas (PHEOs) are neuroendocrine tumours, originating from chromaffin cells in the adrenal medulla. They are either sporadic or hereditary. It is important to identify the hereditary cases, so that patients and relatives with germline mutations can be offered regular surveillance. The objective of this study was the detection of pathogenic germline mutations in a cohort of Norwegian PHEO patients. Blood samples and/or formalin-fixed, paraffin-embedded tissue specimens, were collected from 60 patients who were operated upon between 1986 and 2004 at two university hospitals in Norway. DNA mutation analyses were performed successfully in the 42 blood samples and in one of the paraffin-embedded tissue specimen in VHL, RET, SDHB, SDHC, SDHD and NF1. In all, 32 different DNA variants were observed, of which 8 were classified as pathogenic (19 %), or possibly pathogenic; three in NF1, two in RET and VHL and one in SDHB. Two variants were observed in one patient, one in SDHB and one in NF1. Three of these variants are, to the best of our knowledge, new ones; two in NF1 [c.950_51insGCTGA, (p.Glu318LeufsX59) and c.1588G > A, (p.Val530Ile)] and one in VHL (c.308C > T, p.Pro103Leu). In conclusion the overall incidence of germline mutations in genes associated with familial PHEO was found to be of the same order of magnitude in the present Norwegian series as in those from other countries. Two new NF1 variants and one new VHL gene variant were detected.
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Abstract
Pheochromocytomas and paragangliomas are neural crest cell tumors of the adrenal medulla and parasympathetic/sympathetic ganglia, respectively, that are often associated with catecholamine production. Genetic research over the years has led to our current understanding of the association 13 susceptibility genes with the development of these tumors. Most of the susceptibility genes are now associated with specific clinical presentations, biochemical makeup, tumor location, and associated neoplasms. Recent scientific advances have highlighted the role of somatic mutations in the development of pheochromocytoma/paraganglioma as well as the usefulness of immunohistochemistry in triaging genetic testing. We can now approach genetic testing in pheochromocytoma/paraganglioma patients in a very organized scientific way allowing for the reduction of both the financial and emotional burden on the patient. The discovery of genetic predispositions to the development of pheochromocytoma/paraganglioma not only facilitates better understanding of these tumors but will also lead to improved diagnosis and treatment of this disease.
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Affiliation(s)
- Kathryn S King
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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High-throughput screening for the identification of new therapeutic options for metastatic pheochromocytoma and paraganglioma. PLoS One 2014; 9:e90458. [PMID: 24699253 PMCID: PMC3974653 DOI: 10.1371/journal.pone.0090458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
Drug repurposing or repositioning is an important part of drug discovery that has been growing in the last few years for the development of therapeutic options in oncology. We applied this paradigm in a screening of a library of about 3,800 compounds (including FDA-approved drugs and pharmacologically active compounds) employing a model of metastatic pheochromocytoma, the most common tumor of the adrenal medulla in children and adults. The collection of approved drugs was screened in quantitative mode, testing the compounds in compound-titration series (dose-response curves). Analysis of the dose-response screening data facilitated the selection of 50 molecules with potential bioactivity in pheochromocytoma cells. These drugs were classified based on molecular/cellular targets and signaling pathways affected, and selected drugs were further validated in a proliferation assay and by flow cytometric cell death analysis. Using meta-analysis information from molecular targets of the top drugs identified by our screening with gene expression data from human and murine microarrays, we identified potential drugs to be used as single drugs or in combination. An example of a combination with a synergistic effect is presented. Our study exemplifies a promising model to identify potential drugs from a group of clinically approved compounds that can more rapidly be implemented into clinical trials in patients with metastatic pheochromocytoma or paraganglioma.
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Ctvrtlik F, Koranda P, Tichy T. Adrenal disease: a clinical update and overview of imaging. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:23-34. [PMID: 24621966 DOI: 10.5507/bp.2014.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 02/13/2014] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this article is to provide an overview of the most frequent clinically significant adrenal diseases and to describe the latest trends in their diagnostics, particularly by means of imaging techniques. METHODS The authors reviewed standard textbooks and subsequently conducted a search using the PubMed (Public/Publisher MEDLINE) electronic database by the year 2013 with the following search terms: adrenal masses, adrenal adenoma, phaeochromocytoma, adrenocortical carcinoma, metastases, incidentalomas, hypercortisolism, hyperaldosteronism. RESULTS If adrenal disease is clinically suspected, hormone tests are performed to detect adrenal hyperfunction and imaging studies are used to assess the nature of adrenal lesion. The most frequent syndromes include hypercortisolism, primary hyperaldosteronism, and phaeochromocytoma. The clinically most significant pathologies of the adrenal glands are adenomas and adrenal hyperplasia, adrenocortical carcinomas, phaeochromocytomas, and metastases. Given the availability and improved quality of imaging techniques, adrenal incidentalomas are detected increasingly often. In these cases, it is necessary to rule out hormonal activity and malignancy. Incidentalomas can be associated with clinical syndromes of adrenal hormone overproduction. In most cases, they are clinically silent. In some cases, the definitive diagnosis can be determined as early as during the initial examination with an imaging technique (most frequently, a CT scan). If the finding is inconsistent, other imaging techniques can be used: CT contrast washout analysis, MRI, SPECT or PET/CT. CONCLUSION In the case of adrenal gland disorders, correct interpretation of the results of laboratory tests and imaging studies is essential for further management of these patients.
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Affiliation(s)
- Filip Ctvrtlik
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Martucci VL, Pacak K. Pheochromocytoma and paraganglioma: diagnosis, genetics, management, and treatment. Curr Probl Cancer 2014; 38:7-41. [PMID: 24636754 DOI: 10.1016/j.currproblcancer.2014.01.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kim JH, Seong MW, Lee KE, Choi HJ, Ku EJ, Bae JH, Park SS, Choi SH, Kim SW, Shin C, Kim SY. Germline mutations and genotype-phenotype correlations in patients with apparently sporadic pheochromocytoma/paraganglioma in Korea. Clin Genet 2013; 86:482-6. [PMID: 24134185 DOI: 10.1111/cge.12304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/27/2013] [Accepted: 10/15/2013] [Indexed: 11/29/2022]
Abstract
The aim of our study was to assess the frequency of germline mutations and develop the genetic testing strategy in patients with apparently sporadic pheochromocytoma/paraganglioma (PPGL) in Korea. We included 53 patients diagnosed with non-syndromic PPGL without a family history of PPGLs in three referral centers from 2004 to 2011. Succinate dehydrogenase complex B (SDHB), SDHD, Von Hippel-Lindau (VHL), and rearranged during transfection (RET) genes were examined by direct sequencing and multiple ligation-dependent probe amplification. The study patients were composed of 26 men and 27 women, and mean age was 50.1 ± 13.5 years. The frequency of germline mutations was 13.2% (7/53): RET (n = 2), VHL (n = 1), SDHB (n = 2), and SDHD (n = 2). Six of seven mutation carriers were diagnosed before the age of 50. One of two patients harboring an SDHB mutation had malignant PPGLs. One patient with multifocal head and neck paraganglioma (PGL) and pheochromocytoma (PHEO) carried a SDHD mutation. The carriers of germline mutations in patients with apparently sporadic PPGL were 13.2% in our study. We recommend genetic testing in patients below 50 years and SDHD genetic testing in patients with multifocal PPGLs. In malignant PPGLs, SDHB genetic testing may be performed.
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Affiliation(s)
- J H Kim
- Department of Internal medicine, Seoul National University College of Medicine, Seoul, South Korea
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Marx SJ. Multiplicity of hormone-secreting tumors: common themes about cause, expression, and management. J Clin Endocrinol Metab 2013; 98:3139-48. [PMID: 23771922 PMCID: PMC3733851 DOI: 10.1210/jc.2013-1511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Multiplicity of hormone-secreting tumors occurs in a substantial portion of hormone-excess states. Multiplicity increases the difficulty of management and drives the selection of special strategies. EVIDENCE ACQUISITION This is a synthesis from publications about tumor development and expression, and also about types of clinical strategy for hormone-secreting tumors. EVIDENCE SYNTHESIS Comparisons were made between patient groups with solitary tumors vs those with multiple tumors. Major themes with clinical relevance emerged. Usually, tumor multiplicity develops from a genetic susceptibility in all cells of a tissue. This applies to hormone-secreting tumors that begin as either polyclonal (such as in the parathyroids of familial hypocalciuric hypercalcemia) or monoclonal tumors (such as in the parathyroids of multiple endocrine neoplasia type 1 [MEN1]). High penetrance of a hereditary tumor frequently results in bilaterality and in several other types of multiplicity. Managements are better for the hormone excess than for the associated cancers. Management strategies can be categorized broadly as ablation that is total, subtotal, or zero. Examples are discussed for each category, and 1 example of each category is named here: 1) total ablation of the entire tissue with effort to replace ablated functions (for example, in C-cell neoplasia of multiple endocrine neoplasia type 2); 2) subtotal ablation with increased likelihood of persistent disease or recurrent disease (for example, in the parathyroid tumors of MEN1); or 3) no ablation of tissue with or without the use of pharmacotherapy (for example, with blockers for secretion of stomach acid in gastrinomas of MEN1). CONCLUSIONS Tumor multiplicity usually arises from defects in all cells of the precursor tissue. Even the optimized managements involve compromises. Still, an understanding of pathophysiology and of therapeutic options should guide optimized management.
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Affiliation(s)
- Stephen J Marx
- Genetics and Endocrinology Section, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Taïeb D, Timmers HJ, Hindié E, Guillet BA, Neumann HP, Walz MK, Opocher G, de Herder WW, Boedeker CC, de Krijger RR, Chiti A, Al-Nahhas A, Pacak K, Rubello D. EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2012; 39:1977-95. [PMID: 22926712 DOI: 10.1007/s00259-012-2215-8] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. METHODS Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. CONCLUSION Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France.
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