Selects specific genes to test for PPGL based on clinical presentation and phenotypic characteristics. Indications include abdominal/PGL with metastasis risk (test SDHB), head/neck PGL (test SDHD), bilateral PCC or pancreatic lesions (test VHL), and MEN2-associated mucosal neuromas or medullary thyroid cancer (test RET).
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name: ppgl-genetic-test-selection
description: Selects specific genes to test for PPGL based on clinical presentation and phenotypic characteristics. Indications include abdominal/PGL with metastasis risk (test SDHB), head/neck PGL (test SDHD), bilateral PCC or pancreatic lesions (test VHL), and MEN2-associated mucosal neuromas or medullary thyroid cancer (test RET).
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# PPGL Genetic Test Selection Based on Clinical Phenotype
## STEP 1 — Gather Information
Collect tumor location (adrenal PCC vs abdominal/head-neck PGL), presence of metastatic disease, family history of PPGL or related syndromes, and clinical signs suggestive of MEN2 (mucosal neuromas, medullary thyroid cancer), VHL (bilateral PCC, pancreatic cysts/lesions), and SDHB/SDHD phenotypes.
## STEP 2 — Rule In / Rule Out
If tumor location is head/neck paraganglioma, proceed to test SDHD; otherwise, rule out SDHD and evaluate for abdominal/PGL or adrenal PCC.
## STEP 3 — Classify or Stratify
Classify phenotype: abdominal or extra-adrenal PGL with metastasis risk/family history → test SDHB; bilateral PCC or pancreatic lesions → test VHL; mucosal neuromas or medullary thyroid cancer → test RET.
## STEP 4 — Decide
Order the indicated genetic test (SDHB, SDHD, VHL, or RET) based on the classification.
## Clinical Guardrails / Mimics / Pitfalls
Do not test SDHB for isolated head/neck PGL without metastasis risk; do not overlook VHL in young patients with bilateral PCC; do not miss RET in patients with mucosal neuromas even without family history; ensure genetic counseling before testing; note that testing is not covered by insurance except for medullary thyroid carcinoma.
## Concrete Clinical Example
A 45-year-old patient with an abdominal paraganglioma and a family history of metastatic PPGL undergoes SDHB testing, which reveals a pathogenic variant, guiding surveillance for metastasis.
**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI:10.1507/endocrj.EJ25-0165
