Abstract
Germline variants in subunit D of the succinate dehydrogenase gene (SDHD variants) are associated with an increased risk of developing paragangliomas. The aim of this study was to compare mortality rates and survival in a Dutch cohort of SDHD variant carriers with those in the general population. The study was conducted at the Leiden University Medical Center, a tertiary referral center for patients with paragangliomas. Included subjects all tested positive for SDHD variants before 1 July 2012 and visited the departments of Otorhinolaryngology or Endocrinology at least once or had a diagnosed paraganglioma and a SDHD variant-positive family history. Clinical data were retrieved from medical records, information on mortality was obtained from the Municipal Personal Records Database, and mortality rates for the Dutch population were obtained from the Dutch Central Bureau of Statistics, stratified by sex, age and date. SDHD variant carriers were followed from the date of first SDHD variant-related contact until death, emigration or 12 December 2012 and the standardized mortality ratio (SMR) was calculated. Two-hundred and seventy-five SDHD variant carriers were included in the study, of which 80% carried the c.274G>T, p.(Asp92Tyr) variant, had a mean duration of follow-up of 7.6 years, yielding 2242 person-years of observation for analysis. There were 18 deaths in the SDHD variant carrier group; two were paraganglioma related. The SMR for the whole cohort was 1.07 (95% confidence interval 0.67-1.73). In conclusion, mortality in SDHD variant carriers is not substantially increased. Additional studies are required to confirm these findings.
Highlights
Germline variants in subunit D of the succinate dehydrogenase (SDH)gene predispose carriers to the development of paragangliomas (PGLs).[1]
By the end of follow-up, a total of 620 head and neck paraganglioma (HNPGL) had been found in 246 patients (89%), with 200 patients showing multiple HNPGLs
Our results show that mortality in SDHD variant carriers is not substantially increased compared with the general population, despite the presence of HNPGL in a majority of variant carriers
Summary
Gene predispose carriers to the development of paragangliomas (PGLs).[1] SDHD variants are mainly associated with multifocal PGLs in the head and neck region (HNPGLs), sympathetic PGLs (sPGLs; extra-adrenal PGLs) and adrenal PGLs (ie, pheochromocytomas, PCC) occur.[2,3,4] the majority of HNPGLs are benign and indolent tumors,[5] their location in close proximity to important neurovascular structures may lead to serious morbidity.[6] Neurovascular complications occur in up to 60% of cases following surgical treatment, for example, cranial nerve injury and lesions to the carotid artery.[7,8] It is of great importance to carefully consider whether HNPGL should be treated, and a ‘wait and scan’ policy is often the best option.[5]. Because of their ability to hypersecrete catecholamines, PCC and sPGLs can give rise to severe cardiovascular complications, such as shock, myocardial infarction, dissecting aortic aneurysms or heart failure due to toxic cardiomyopathy.[9,10,11,12] In order to avoid these potentially lethal complications, adrenalectomy is indicated for PCC,[13] and with implementation of appropriate preoperative care to modulate the effects of catecholamine release, perioperative mortality is nil.[14,15,16]
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