SDHC phaeochromocytoma and paraganglioma: a UK-wide case series

Sophie T. Williams, Prodromos Chatzikyriakou, Paul V. Carroll, Barbara M. McGowan, Anand Velusamy, Gemma White, Rupert Obholzer, Scott Akker, Nicola Tufton, Ruth T. Casey, Eamonn R. Maher, Soo-Mi Park, Mary Porteous, Rebecca Dyer, Tricia Tan, Florian Wernig, Angela F. Brady, Monika Kosicka-Slawinska, Benjamin C. Whitelaw, Huw DorkinsFiona Lalloo, Paul Brennan, Joseph Carlow, Richard Martin, Anna L. Mitchell, Rachel Harrison, Lara Hawkes, John Newell-Price, Alan Kelsall, Rebecca Igbokwe, Julian Adlard, Schaida Schirwani, Rosemarie Davidson, Patrick J. Morrison, Teng-Teng Chung, Christopher Bowles, Louise Izatt

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Phaeochromocytomas and paragangliomas (PPGL) are rare, but strongly heritable tumours. Variants in succinate dehydrogenase (SDH) subunits are identified in approximately 25% of cases. However, clinical and genetic information of patients with SDHC variants are underreported.

DESIGN: This retrospective case series collated data from 18 UK Genetics and Endocrinology departments.

PATIENTS: Both asymptomatic and disease-affected patients with confirmed SDHC germline variants are included.

MEASUREMENTS: Clinical data including tumour type and location, surveillance outcomes and interventions, SDHC genetic variant assessment, interpretation, and tumour risk calculation.

RESULTS: We report 91 SDHC cases, 46 probands and 45 non-probands. Fifty-one cases were disease-affected. Median age at genetic diagnosis was 43 years (range: 11-79). Twenty-four SDHC germline variants were identified including six novel variants. Head and neck paraganglioma (HNPGL, n = 30, 65.2%), extra-adrenal paraganglioma (EAPGL, n = 13, 28.2%) and phaeochromocytomas (PCC) (n = 3, 6.5%) were present. One case had multiple PPGLs. Malignant disease was reported in 19.6% (9/46). Eight cases had non-PPGL SDHC-associated tumours, six gastrointestinal stromal tumours (GIST) and two renal cell cancers (RCC). Cumulative tumour risk (95% CI) at age 60 years was 0.94 (CI: 0.79-0.99) in probands, and 0.16 (CI: 0-0.31) in non-probands, respectively.

CONCLUSIONS: This study describes the largest cohort of 91 SDHC patients worldwide. We confirm disease-affected SDHC variant cases develop isolated HNPGL disease in nearly 2/3 of patients, EAPGL and PCC in 1/3, with an increased risk of GIST and RCC. One fifth developed malignant disease, requiring comprehensive lifelong tumour screening and surveillance.

Original languageEnglish
Pages (from-to)499-512
Number of pages14
JournalClinical Endocrinology
Issue number4
Early online date24 Sept 2021
Publication statusPublished - Apr 2022


  • gastrointestinal tumour
  • paraganglioma
  • phaeochromocytoma
  • rare diseases
  • succinate dehydrogenase


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