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Should genetic testing be performed in each patient with sporadic pheochromocytoma at presentation?

Laboratoire de Biochimie ‘Hormonologie, Métabolisme-Nutrition, Oncologie’, Centre de Biologie et Pathologie, CHRU de Lille, France¹ Service d'Endocrinologie et Métabolismes, Clinique Marc Linquette, CHRU de Lille, 59037 France² Service de Chirurgie Endocrinienne, Hôpital Claude Huriez, CHRU de Lille, France³ Service d'Endocrinologie et Maladies Métaboliques, Hôpital Larrey, CHU de Toulouse, 31059 France

(Correspondence should be addressed to P Pigny; Email: p-pigny{at}chru-lille.fr)

Background: According to previous studies, around 15% of patients with an apparently sporadic pheochromocytoma and a negative family history had a hereditary disease. This high frequency together with the financial support provided to reference laboratories of molecular genetics by the French government led to a nearly systematic screening in each patient with a pheochromocytoma.

Objective: To check the efficiency of systematic genetic screening in patients with apparently sporadic pheochromocytoma, by analysing the 6 years experience of a multidisciplinary team in this field.

Methods: One hundred patients with a pheochromocytoma-only phenotype and no family history were included. Patients with extra-adrenal tumours were excluded. Prevalence of hereditary forms was determined and analyzed according to age at onset, sex. Cost of the genetic analysis was calculated.

Results: A germline mutation in one of the five susceptibility genes (VHL, RET, SDHD, SDHC, SDHB) was identified in eight patients (8%) with an age of onset between 13 and 57 years. Among them, six had a bilateral pheochromocytoma and only two had a unilateral tumour. If the guidelines for genetic screening were age of onset less than 50 or bilateral pheochromocytoma, no patients with a hereditary tumour would be missed and a 24% cost reduction would be achieved.

Conclusions: According to these data, a genetic predisposition test for hereditary pheochromocytoma seems not recommended in patients with a unilateral adrenal tumour diagnosed after 50 in the absence of familial, clinical, biological or imaging features for a familial disease.

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