3 years ago

Estudio de mutaciones germinales en pacientes con feocromocitomas y paragangliomas atendidos en un hospital universitario de tercer nivel: ¿qué pacientes se estudian y qué resultados se encuentran?

Cortes María Jiménez, Rosa Pilar Quílez, César Gonzalvo, Pedro Pinés, María Olmos, Cristina Lamas

Publication date: November 2018

Source: Endocrinología, Diabetes y Nutrición, Volume 65, Issue 9

Author(s): Cortes María Jiménez, Rosa Pilar Quílez, César Gonzalvo, Pedro Pinés, María Olmos, Cristina Lamas

Resumen
Introducción

Las actuales guías de práctica clínica recomiendan considerar el estudio genético en todos los pacientes con diagnóstico de feocromocitoma o paraganglioma (PPGL). El objetivo de nuestro trabajo es conocer el porcentaje de solicitud de estudio genético en el PPGL en un hospital universitario no especializado, los factores implicados en dicha solicitud, cuántos de ellos presentan mutación germinal, cuáles son los genes afectados y qué variables se relacionan con la presencia de mutaciones.

Material y métodos

Se incluyó a todos los pacientes con PPGL diagnosticados en el área sanitaria de un hospital universitario de tercer nivel entre 2010 y 2015. Se recogieron las variables: edad, localización, único o múltiple, secreción hormonal, cuadro sindrómico, antecedentes familiares y servicio responsable. Se comparó a los pacientes con estudio genético realizado (GEN+) frente a aquellos no estudiados (GEN–), y pacientes con mutación (MUT+) frente a aquellos sin mutación predisponente (MUT–).

Resultados

Se incluyó a 39 pacientes (21 mujeres y 18 varones con edad media 53,9 ± 17,8 años). Se hizo estudio genético al 54% y estos eran más jóvenes, con antecedentes familiares, múltiples, secretores y con mayor frecuencia vistos por Endocrinología. Hubo menos paragangliomas de cabeza y cuello unilaterales. Un 33% tenía mutación germinal (3 RET, 3 SDHB, un SDHD) y estos eran más jóvenes, más sindrómicos, múltiples o con antecedentes familiares.

Conclusiones

Aunque las guías de práctica clínica recomiendan considerar la realización de un estudio genético a todos los pacientes con PPGL, en nuestra Área de Salud se solicitó en el 54% de ellos. Un 33% de ellos presentaron mutación germinal predisponente.

Abstract
Introduction

Current clinical practice guidelines recommend that a genetic study is considered in all patients diagnosed with pheochromocytoma or paraganglioma (PPGL). Our study objective was to know how many patients with PPGL undergo genetic studies at a non-specialized university hospital, the clinical factors involved in the decision to make the study, how many patients are found germline mutation, which are the affected genes, and what variables are related to presence of mutations.

Material and methods

All patients diagnosed with PPGL at a tertiary university hospital from 2010 to 2015 were enrolled. Age and sex, tumor location and multiplicity, hormone secretion, presence of a clinical syndrome, family history, and medical department in charge were recorded and used to compare patients with (GEN + ) and without (GEN-) genetic study, as well as patients with (MUT + ) and without (MUT-) germline mutations.

Results

Thirty-nine patients were enrolled (21 females and 18 males with a mean age of 53.9 ± 17.8 years). A genetic study was performed in 54% of patients with PPGL. These were younger, were more frequently seen by endocrinologists, and had more often a family history related to PPGL, multiple PPGLs, or hormonally functional tumors. Unilateral head and neck paragangliomas were less common. Germline mutations (3 RET, 3 SDHB, 1 SDHD) were found in 33% of patients, who were younger and more frequently had a clinical syndrome, multiple PPGLs. and a family history of PPGL.

Conclusion

Although current clinical practice guidelines recommend that genetic studies are considered in all patients diagnosed with PPGL, studies was requested for 54% of such cases in our healthcare area. Predisposing germline mutations were found in 33% of studies.

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