• What are PPGL Syndromes?

    PPGL syndromes are conditions that may cause tumours called paraganglioma or phaeochromocytoma. These syndromes are caused by gene changes (mutations) that can be passed down in families. Sometimes the tumours may make greater than normal amounts of hormones, the body’s chemical messengers, which in turn may cause a range of different symptoms. These tumours grow in particular cells of the body that mean that they are classed as neuroendocrine tumours or neoplasms (NET or NEN).  All the tumours in PPGL syndromes can occur alone (sporadic) and separately from an inherited syndrome.

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  • Phaeochromocytomas
  • Parargangliomas

  • How are PPGL Syndromes Diagnosed?

    A person may be diagnosed with an inherited PPGL syndrome after being offered a gene test.  Genetic testing may be offered either after someone is diagnosed with a paraganglioma or phaeochromocytoma, or because there is a family history of a PPGL syndrome.  In this way, some people may be diagnosed with a syndrome before they have developed any tumours.  In addition, some people diagnosed by gene test with a syndrome may not actually develop any tumours in their lifetime.

    The table below shows each type of PPGL syndrome currently known.  It also shows the lifetime risk of people with each gene change (but without tumours currently) for developing different types of tumours:

    Table 1: risks of tumours in unaffected individuals with gene mutations

    Gene Risk of any tumour (lifetime) Most likely position of tumour Multiple tumours Other tumours (not PGL / Phaeo)
    SDHB 25-30% Adrenal and extra adrenal PGL 30% Renal cell carcinoma, GIST
    SDHD 50-90%* Head and neck 50% Rarely GIST and renal cell carcinoma
    SDHA less than 10% Adrenal and extra adrenal PGL rarely GIST
    SDHAF2** 5% Head and neck 90% Not reported
    SDHC up to 25% Head and neck and extra adrenal PGL GIST, rarely renal cell carcinoma
    MAX* 30-50% Adrenal 60% Not reported
    TMEM127* 40-80% Adrenal 25% Not reported

    * If inherited from the father.  Risk stated for SDHD is based on published literature and collective clinical observation including the recent consensus opinion of a large group of experts (Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variants, The Lancet, 2023; 11:345-61)

    ** Data is limited as numbers of cases are small and therefore the tumour risks are likely to be overestimates

     

    Regular Screening in PPGL Syndromes

    After any initial treatment has been done, anyone with a PPGL gene change (and therefore a PPGL syndrome) should enter a long-term screening programme.  In this way, any other tumours should be found earlier before symptoms occur.  This should also make treatment easier.  The programme would be similar for people who have already had treatment, and for those who are not yet affected (and may not be affected during their lifetime).

    Most regional genetics services would suggest the following in the table below for most of the syndromes. However, if a child/adult has inherited a SDHD, SDHAF2 or MAX mutation from their mother, screening is not suggested as only mutations inherited from their father will mean that they develop tumours.

     

    Gene Recommended surveillance
    SDHB ·       Annual hospital appointments and blood tests·       Abdominal imaging* at baseline and if normal every 12-24 months

    ·       MRI/CT neck, chest at baseline and if normal every 3 years

     
    SDHD ·       Screening should only be offered to patients who have a gene change passed down from their father.·       Annual hospital appointments and blood tests

    ·       Abdominal imaging* and MRI/CT neck, chest at baseline and if normal every 3 years

     
    SDHC ·       Annual hospital appointments and blood tests·       Abdominal imaging* and MRI/CT neck, chest at baseline and if normal every 3 years

     
    SDHA ·       Annual hospital appointments and blood tests·       Abdominal imaging* and MRI/CT neck, chest at baseline and if normal every 3-5 years

     
    SDHAF2** ·       Screening should only be offered to patients who have a gene change passed down from their father·       Annual hospital appointments and blood tests

    ·       Abdominal imaging* at baseline and if normal every 3 years

    ·       MRI of neck, chest at baseline and if normal every 5 years

     
    MAX** ·       Screening should only be offered to patients who have a gene change passed down from their father·       Annual hospital appointments and blood tests

    ·       Abdominal imaging* at baseline and if normal every 3 years

    ·       MRI of neck, chest at baseline and if normal every 5 years

     
    TMEM127** ·       Annual hospital appointments and blood tests·       Abdominal imaging* at baseline and if normal every 3 years

    ·       MRI of neck, chest at baseline and if normal every 5 years

     

    *MRI is the preferred method of screening but CT may be required in some instances if MRI not tolerated or unavailable.

     

    For more detailed information on diagnosis, testing and treatment, please download our booklets below.

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Further Reading

  • Hereditary Phaeo Para Syndromes

    August 2020 [update pending]

    View Booklet

  • Phaeochromocytomas

    2023 Update.  This booklet is primarily regarding non-inherited phaeochromocytomas but may be useful.  We recommend that you discuss the content of this booklet with your specialist - it is not for use in self-diagnosis, and not all of the information it contains may be relevant to you.

    View Booklet

  • RADIOLIGAND THERAPY (RLT) e.g. PRRT

    Produced by the International Neuroendocrine Cancer Alliance (INCA) in 2025, this patient leaflet provides detailed information on Radioligand Therapy such as PRRT.

    Click here to view and download

  • NCUK RLT Booklet

    A resource on RLT (such as PRRT) by  our colleagues at UK-based Neuroendocrine Cancer UK

    Click here to view and download

Patient Experience Films

  • Introducing PPGL (SDH) Syndromes – Patient Experience Films

    We are truly grateful to Karen Williams, Andy Price and Crystal Miller for sharing their experiences in our films, produced in early 2020. Produced by Red Goat Productions.

    We hope that you find them useful, interesting and stimulating.

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  • Introducing SDH Syndromes - Diagnosis

  • Introducing SDH Syndromes - Treatment

  • Introducing SDH Syndromes - Future

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