Pheochromocytoma and paraganglioma: changing vision

A tumor of the adrenal medulla is also known as a pheochromocytoma. These tumors produce excessive stress hormones. Until recently, reliable epidemiological data were limited. With this research, we have provided accurate epidemiological information. Over the years, the number of CT and MRI-scans has steadily increased, subsequently raising the likelihood of incidentally discovered adrenal abnormalities. We have demonstrated that the majority of these adrenal abnormalities do not require further investigation for the presence of a pheochromocytoma. This novel strategy proves to be more efficient and cost-effective. Surgical removal offers the only option for cure, but is a hazardous procedure. During surgery, stress hormones can be released from the tumor. We have outlined the optimal approach to perioperative treatment. To facilitate a more personalized approach, we identified factors enabling a more reliable prediction of individual surgical risk. Despite optimal surgical removal, some patients may still develop metastases. Due to the lack of predictive characteristics, it is not possible to determine reliably whether a tumor limited to the adrenal gland will demonstrate a benign course or develop metastases in the future. By applying a new technique based on molecular analysis of tumor tissue, we studied the consequences of DNA and RNA variations within and among tumors. We discovered certain variations at the RNA level that were detectable in the primary tumor prior to the development of metastases. This finding could offer the potential for better prognostication and might for many patients obviate the need of long-term follow-up in the future.