Paraganglioma

disease
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Also known as chemodectomaneoplasm of paraganglionneoplasm of the paraganglionparagangliomasparaganglion neoplasmparaganglion tumorparaganglion tumourParaganglionic neoplasmParaganglionic tumorParaganglionic tumourtumor of paragangliontumor of the paragangliontumour of paragangliontumour of the paraganglion

Summary

Paraganglioma (MONDO:0000448) is a disease (an umbrella term covering 12 Mondo subtypes) with 3 cohort genes and 77 clinical trials. The dominant Reactome pathway is Maturation of TCA enzymes and regulation of TCA cycle (3 cohort genes). Top therapeutic interventions include phenoxybenzamine, edotreotide gallium ga-68, and cabozantinib.

At a glance

  • Umbrella term: 12 Mondo subtypes
  • Cohort genes: 3
  • ClinVar variants: 7
  • Clinical trials: 77

Clinical features

No curated clinical features (Orphanet) for this disease.

Identifiers

Disease identifiers

FieldValue
Canonical nameparaganglioma
Mondo IDMONDO:0000448
EFOEFO:1000453
MeSHD010235
DOIDDOID:0050773
NCITC3308
SNOMED CT127027008
UMLSC0030421
MedGen10571
GARD0022770
Anatomy (UBERON)UBERON:0002410
Is cancer (heuristic)no

Also known as: chemodectoma · neoplasm of paraganglion · neoplasm of the paraganglion · paraganglioma · paragangliomas · paraganglion neoplasm · paraganglion tumor · paraganglion tumour · Paraganglionic neoplasm · Paraganglionic tumor · Paraganglionic tumour · tumor of paraganglion · tumor of the paraganglion · tumour of paraganglion · tumour of the paraganglion

Data availability: 7 ClinVar variants · 11 intOGen driver records.

Disease family

An umbrella term covering 12 Mondo subtypes.

Classification path: disease › human disease › disease by body system or component › nervous system disordercentral nervous system disorderautonomic nervous system disorderautonomic nervous system neoplasmparaganglioma

Related subtypes (2): sympathetic neurilemmoma, ganglioneuroma

Subtypes (12): head and neck paraganglioma, pheochromocytoma/paraganglioma syndrome 4, pheochromocytoma/paraganglioma syndrome 1, pheochromocytoma/paraganglioma syndrome 2, pheochromocytoma/paraganglioma syndrome 3, pheochromocytoma/paraganglioma syndrome 5, sporadic pheochromocytoma/secreting paraganglioma, non-secreting paraganglioma, parasympathetic paraganglioma, sympathetic paraganglioma, pheochromocytoma/paraganglioma syndrome 6, pheochromocytoma/paraganglioma syndrome 7

Genetics & variants

GWAS landscape

No GWAS associations recorded — common-variant (GWAS) studies don’t cover this disease (typical for Mendelian / rare diseases). See the curated gene cohort and Mendelian overlap below.

Variant details and genetic-evidence tiers

ClinVar germline variants

7 retrieved; paginated sample, class counts are floors:

3 pathogenic/likely pathogenic, 2 conflicting classifications of pathogenicity, 1 benign/likely benign, 1 likely pathogenic

ClinVarVariant (HGVS)GeneClassificationReview
239647NM_004168.4(SDHA):c.1432_1432+1delSDHAPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1687624NM_003000.3(SDHB):c.206G>T (p.Gly69Val)SDHBPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
231390NM_003002.4(SDHD):c.147dup (p.His50fs)SDHDPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
428929NM_003000.3(SDHB):c.744C>G (p.Asn248Lys)SDHBLikely pathogeniccriteria provided, multiple submitters, no conflicts
472322NM_004168.4(SDHA):c.1334C>T (p.Ser445Leu)SDHAConflicting classifications of pathogenicitycriteria provided, conflicting classifications
1687625NM_003002.4(SDHD):c.242C>G (p.Pro81Arg)SDHDConflicting classifications of pathogenicitycriteria provided, conflicting classifications
36768NM_003000.3(SDHB):c.32G>A (p.Arg11His)SDHBBenign/Likely benigncriteria provided, multiple submitters, no conflicts

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 0 · Orphanet: 19 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
SDHBOrphanet:139411Carney triad
SDHBOrphanet:201Cowden syndrome
SDHBOrphanet:276621Sporadic pheochromocytoma/secreting paraganglioma
SDHBOrphanet:29072Hereditary pheochromocytoma-paraganglioma
SDHBOrphanet:3208Isolated succinate-CoQ reductase deficiency
SDHBOrphanet:44890Gastrointestinal stromal tumor
SDHBOrphanet:97286Carney-Stratakis syndrome
SDHAOrphanet:139411Carney triad
SDHAOrphanet:154Familial isolated dilated cardiomyopathy
SDHAOrphanet:29072Hereditary pheochromocytoma-paraganglioma
SDHAOrphanet:3208Isolated succinate-CoQ reductase deficiency
SDHAOrphanet:44890Gastrointestinal stromal tumor
SDHAOrphanet:97286Carney-Stratakis syndrome
SDHDOrphanet:100093Carcinoid syndrome
SDHDOrphanet:201Cowden syndrome
SDHDOrphanet:276621Sporadic pheochromocytoma/secreting paraganglioma
SDHDOrphanet:29072Hereditary pheochromocytoma-paraganglioma
SDHDOrphanet:3208Isolated succinate-CoQ reductase deficiency
SDHDOrphanet:97286Carney-Stratakis syndrome

Cohort genes → proteins

3 cohort genes, 3 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence3

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
SDHBHGNC:10681ENSG00000117118P21912Succinate dehydrogenase [ubiquinone] iron-sulfur subunit, mitochondrialclinvar,civic_evidence
SDHAHGNC:10680ENSG00000073578P31040Succinate dehydrogenase [ubiquinone] flavoprotein subunit, mitochondrialclinvar
SDHDHGNC:10683ENSG00000204370O14521Succinate dehydrogenase [ubiquinone] cytochrome b small subunit, mitochondrialclinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
SDHBSuccinate dehydrogenase [ubiquinone] iron-sulfur subunit, mitochondrialIron-sulfur protein (IP) subunit of the succinate dehydrogenase complex (mitochondrial respiratory chain complex II), responsible for transferring electrons from succinate to ubiquinone (coenzyme Q).
SDHASuccinate dehydrogenase [ubiquinone] flavoprotein subunit, mitochondrialFlavoprotein (FP) subunit of succinate dehydrogenase (SDH) that is involved in complex II of the mitochondrial electron transport chain and is responsible for transferring electrons from succinate to ubiquinone (coenzyme Q).
SDHDSuccinate dehydrogenase [ubiquinone] cytochrome b small subunit, mitochondrialMembrane-anchoring subunit of succinate dehydrogenase (SDH) that is involved in complex II of the mitochondrial electron transport chain and is responsible for transferring electrons from succinate to ubiquinone (coenzyme Q).

Protein-family classification

Druggable: 1 · Difficult: 0 · Unknown: 2 · Druggable fraction: 0.33

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Enzyme (other)14.0×0.460
Other/Unknown21.2×0.587

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
SDHBEnzyme (other)yes1.3.5.12Fe-2S_ferredoxin-type, Succ_DH/fum_Rdtase_Fe-S, 2Fe2S_fd_BS
SDHAOther/UnknownnoFRD_SDH_FAD_BS, FAD-dep_OxRdtase_2_FAD-bd, Succ_DH_flav_su_fwd
SDHDOther/UnknownnoCybS, SQR/QFR_C/D

Expression context

Cohort genes with no expression data: 0.

3 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)3
unknown0

Top tissues across cohort

TissueCohort genes
apex of heart2
heart left ventricle2
cardiac ventricle1
mucosa of transverse colon1
jejunal mucosa1
jejunum1
rectum1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
SDHB293ubiquitousmarkerheart left ventricle, cardiac ventricle, apex of heart
SDHA143ubiquitousmarkerapex of heart, heart left ventricle, mucosa of transverse colon
SDHD287ubiquitousmarkerjejunal mucosa, rectum, jejunum

Protein interactions among cohort

Intra-cohort edges: 3.

Hub genes (top 10 by interactor count)

SymbolInteractor count
SDHA6,141
SDHB5,471
SDHD2,229

Intra-cohort edges

ABSources
SDHASDHBbiogrid_interaction, intact, string_interaction
SDHASDHDstring_interaction
SDHBSDHDbiogrid_interaction, string_interaction

Structural data

PDB: 3 · AlphaFold-only: 0 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
SDHBP219126
SDHAP310405
SDHDO145212

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 5. Enrichment computed across 3 evidence-associated genes (3 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 3 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Maturation of TCA enzymes and regulation of TCA cycle3571.0×2e-08SDHB, SDHA, SDHD
Citric acid cycle (TCA cycle)3423.0×3e-08SDHB, SDHA, SDHD
Respiratory electron transport395.2×2e-06SDHB, SDHA, SDHD
Aerobic respiration and respiratory electron transport259.0×5e-04SDHB, SDHA
Metabolism27.7×0.021SDHB, SDHA

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 3 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
mitochondrial electron transport, succinate to ubiquinone33370.4×1e-10SDHB, SDHA, SDHD
tricarboxylic acid cycle3510.7×3e-08SDHB, SDHA, SDHD
proton motive force-driven mitochondrial ATP synthesis3263.3×2e-07SDHB, SDHA, SDHD
succinate metabolic process22246.9×5e-07SDHB, SDHA
respiratory electron transport chain2561.7×7e-06SDHB, SDHA
regulation of catecholamine secretion15617.3×3e-04SDHD
aerobic respiration182.6×0.016SDHB
cellular response to hypoxia140.4×0.028SDHD
nervous system development115.3×0.064SDHA

Therapeutics

Drugs indicated for this disease

0 approved, 16 in late-stage (phase 3) trials. Disease-direct ChEMBL indications, not inferred from the associated-gene cohort below.

DrugDevelopment status
Albumin HumanPhase 3 (in late-stage trials)
Aminolevulinic AcidPhase 3 (in late-stage trials)
Ascorbic AcidPhase 3 (in late-stage trials)
BevacizumabPhase 3 (in late-stage trials)
CarboplatinPhase 3 (in late-stage trials)
CarmustinePhase 3 (in late-stage trials)
DextroamphetaminePhase 3 (in late-stage trials)
DianhydrogalactitolPhase 3 (in late-stage trials)
DordavipronePhase 3 (in late-stage trials)
DoxazosinPhase 3 (in late-stage trials)
LomustinePhase 3 (in late-stage trials)
PaclitaxelPhase 3 (in late-stage trials)
PhenoxybenzaminePhase 3 (in late-stage trials)
TemozolomidePhase 3 (in late-stage trials)
Tranexamic AcidPhase 3 (in late-stage trials)
VorasidenibPhase 3 (in late-stage trials)

Earlier-phase candidates (phase 2, investigational — efficacy not yet established): ANG1005, ANTINEOPLASTON A10, Abemaciclib, Afatinib, Avelumab, Axitinib, Azacitidine, Bortezomib, Capecitabine, Celecoxib, Cilengitide, Cisplatin, Copper, Crenolanib, Dasatinib Anhydrous, Disulfiram, Doxorubicin, Edotreotide, Epacadostat, Etoposide, Everolimus, Infigratinib, Influenza Virus Vaccine, Iobenguane, Irinotecan, Ivosidenib, Keyhole Limpet Hemocyanin, Lacosamide, Lanreotide, Lapatinib, Lenvatinib, Levetiracetam, Marizomib, Mirtazapine, Nilotinib, Nimotuzumab, Nivolumab, PEGINTERFERON ALFA-2B, Pazopanib, Pembrolizumab, Penpulimab, Retifanlimab, Rivoceranib, Selinexor, Sirolimus, Tetanus Toxoid, Thalidomide, Tipifarnib, Vinblastine, Vismodegib.

Drug target analysis

Approved (phase 4): 1 · Phase ≥3: 1 · Phased (≥1): 1 · Undrugged: 2

Druggability breadth: 2 of 3 evidence-associated genes (67%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Genes with an approved drug

The molecule shown is one approved compound that hits the gene — not necessarily a drug of choice or one indicated for this disease.

SymbolExample approved molecule
SDHALINEZOLID

Top cohort targets by molecule count

SymbolMoleculesMax phase
SDHA14
SDHB00
SDHD00

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
LINEZOLID4SDHA

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 1.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
SDHB4Binding:4
SDHA3Binding:3

Cohort enzymes (BRENDA EC)

SymbolEC numbersNames
SDHB1.3.5.1succinate dehydrogenase

Pharmacogenomics

Cohort genes with a PharmGKB record: 3; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

1 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

CompoundMax phaseCohort target (bioactivity)
LINEZOLID4SDHA

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)1SDHA
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug1SDHB
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug1SDHD

Undrugged target profiles

2 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
SDHB4SDHA
SDHD0SDHA

Clinical trials & evidence

Clinical trials

Clinical trials: 77.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified34
PHASE225
PHASE1/PHASE27
PHASE15
PHASE42
PHASE32
EARLY_PHASE12

Top trials by phase / activity

NCTPhaseStatusTitle
NCT04081701PHASE4RECRUITING68-Ga DOTATATE PET/MRI in the Diagnosis and Management of Somatostatin Receptor Positive CNS Tumors.
NCT05702944PHASE4RECRUITINGThe Effect and Safety of Omitting Preoperative Alpha-adrenergic Blockade for Normotensive Pheochromocytoma
NCT01373736PHASE3UNKNOWN123I-MIBG Scintigraphy in Patients Being Evaluated for Neuroendocrine Tumors
NCT03176693PHASE3COMPLETEDPreoperative Alpha Blockade for Pheochromocytoma
NCT02721732PHASE2ACTIVE_NOT_RECRUITINGPembrolizumab in Treating Patients With Rare Tumors That Cannot Be Removed by Surgery or Are Metastatic
NCT02834013PHASE2ACTIVE_NOT_RECRUITINGNivolumab and Ipilimumab in Treating Patients With Rare Tumors
NCT03206060PHASE2RECRUITINGLu-177-DOTATATE (Lutathera) in Therapy of Inoperable Pheochromocytoma/ Paraganglioma
NCT03839498PHASE2ACTIVE_NOT_RECRUITINGStudy of Axitinib (AG-013736) With Evaluation of the VEGF-pathway in Pheochromocytoma/Paraganglioma
NCT03946527PHASE2ACTIVE_NOT_RECRUITINGLAnreotide in Metastatic Pheochromocytoma / PARAganglioma (LAMPARA)
NCT04394858PHASE2ACTIVE_NOT_RECRUITINGTesting the Addition of an Anticancer Drug, Olaparib, to the Usual Chemotherapy (Temozolomide) for Advanced Neuroendocrine Cancer
NCT04711135PHASE2ACTIVE_NOT_RECRUITINGStudy to Evaluate Safety and Dosimetry of Lutathera in Adolescent Patients With GEP-NETs and PPGLs
NCT05142241PHASE2ACTIVE_NOT_RECRUITINGTesting the Combination of Anti-Cancer Drugs Talazoparib and Temozolomide in Patients With Advanced Stage Rare Cancers, RARE 2 Trial
NCT05636618PHASE1/PHASE2RECRUITINGTargeted Alpha-Particle Therapy for Advanced Somatostatin Receptor Type 2 (SSTR2) Positive Tumors
NCT06045260PHASE2RECRUITINGReceptor Radionuclide Therapy With 177Lu-DOTATOC
NCT06121271PHASE2NOT_YET_RECRUITINGTrial of Lu-177 DOTATATE (Lutathera®) in Unlicensed Indications
NCT06427798PHASE1/PHASE2RECRUITINGSomatostatin-Receptors (SSTR)-Agonist [212Pb]VMT-alpha-NET in Metastatic or Inoperable SSTR+ Gastrointestinal Neuroendocrine Tumor and Pheochromocytoma/Paraganglioma Previously Treated With Systemic Targeted Radioligand Therapy
NCT06607692PHASE1/PHASE2RECRUITINGStudy in Children and Adolescents of 177Lu-DOTATATE (Lutathera®) Combined With the PARP Inhibitor Olaparib for the Treatment of Recurrent or Relapsed Solid Tumours Expressing Somatostatin Receptor (SSTR) (LuPARPed).
NCT00458952PHASE1/PHASE2COMPLETEDPhase 1 Study of Iobenguane (MIBG) I 131 in Patients With Malignant Pheochromocytoma/Paraganglioma
NCT00843037PHASE2COMPLETEDStudy Of Sunitinib In Patients With Recurrent Paraganglioma/Pheochromocytoma
NCT00874614PHASE2UNKNOWNA Study Evaluating Ultratrace Iobenguane I131 in Patients With Malignant Relapsed/Refractory Pheochromocytoma/Paraganglioma
NCT01340794PHASE2TERMINATEDPazopanib Hydrochloride in Treating Patients With Advanced or Progressive Malignant Pheochromocytoma or Paraganglioma
NCT01413503PHASE2COMPLETEDA Phase II Study of 131I- Metaiodobenzylguanidine (MIBG) for Treatment of Metastatic or Unresectable Pheochromocytoma and Related Tumors
NCT01560260PHASE2COMPLETEDLinsitinib in Treating Patients With Gastrointestinal Stromal Tumors
NCT01635907PHASE2COMPLETEDDovitinib in Neuroendocrine Tumors
NCT01967576PHASE2COMPLETEDPhase II Study of Axitinib (AG-013736) With Evaluation of the VEGF-pathway in Metastatic, Recurrent or Primary Unresectable Pheochromocytoma/Paraganglioma
NCT02177773PHASE1/PHASE2TERMINATEDGA-68 DOTA-TOC of Somatostatin Positive Malignancies
NCT02302833PHASE2COMPLETEDCabozantinib S-malate in Treating Patients With Metastatic Pheochromocytomas or Paragangliomas That Cannot Be Removed by Surgery
NCT03165721PHASE2TERMINATEDA Phase II Trial of the DNA Methyl Transferase Inhibitor, Guadecitabine (SGI-110), in Children and Adults With Wild Type GIST,Pheochromocytoma and Paraganglioma Associated With Succinate Dehydrogenase Deficiency and HLRCC-associated Kidney Cancer
NCT03923257PHASE1/PHASE2WITHDRAWNDosimetry Guided PRRT With 177Lu-DOTATATE in Children and Adolescents
NCT04106843PHASE2WITHDRAWNRadioactive Drug (177Lu-DOTATATE) for the Treatment of Locally Advanced, Metastatic, or Unresectable Rare Endocrine Cancers
NCT04187404PHASE1/PHASE2TERMINATEDA Novel Therapeutic Vaccine (EO2401) in Metastatic Adrenocortical Carcinoma, or Malignant Pheochromocytoma/Paraganglioma
NCT04276597PHASE2WITHDRAWNPhase-II Study of Lu177DOTATOC in Adults With STTR(+)Pulmonary, Pheochromocytoma, Paraganglioma, Unknown Primary, Thymus NETs (PUTNET), or Any Other Non-.GEP-NET.
NCT04400474PHASE2COMPLETEDTrial of Cabozantinib Plus Atezolizumab in Advanced and Progressive Neoplasms of the Endocrine System. The CABATEN Study
NCT05883085PHASE2UNKNOWNA Study on the Safety and Effectiveness of Anlotinib for Neoadjuvant Treatment of PPGL
NCT05885386PHASE2UNKNOWNA Study on the Safety and Effectiveness of Temozolomide for Neoadjuvant Treatment of PPGL
NCT06233903PHASE2WITHDRAWN18F-mFBG Expression in Neural Crest Tumors and Organs Innervated by the Sympathetic Nervous System
NCT04119024PHASE1RECRUITINGGene Modified Immune Cells After Conditioning Regimen for the Treatment of Stage IIIC or IV Melanoma or Metastatic Solid Tumors
NCT00339131PHASE1COMPLETEDULTRATRACE Iobenguane I 131 in Patients With Malignant Pheochromocytoma, Paraganglioma, or Metastatic Carcinoid
NCT01155258PHASE1COMPLETEDTemsirolimus and Vinorelbine Ditartrate in Treating Patients With Unresectable or Metastatic Solid Tumors
NCT01204476PHASE1COMPLETEDCixutumumab, Everolimus, and Octreotide Acetate in Treating Patients With Advanced Low to Intermediate Grade Neuroendocrine Carcinoma

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
PHENOXYBENZAMINE46
EDOTREOTIDE GALLIUM GA-6845
CABOZANTINIB43
DOXAZOSIN43
LUTETIUM OXODOTREOTIDE LU-17743
AXITINIB42
IOBENGUANE I 13142
LANREOTIDE41
OCTREOTIDE ACETATE41
PAZOPANIB HYDROCHLORIDE41
PIFLUFOLASTAT F1841
VANDETANIB41
FLORBENGUANE F1832
CATEQUENTINIB HYDROCHLORIDE31
DOVITINIB31
GUADECITABINE31
LINSITINIB31
LUTETIUM LU177 EDOTREOTIDE22
CIXUTUMUMAB21
TIGOZERTINIB21
CHEMBL393930702
CHEMBL27511701
CHEMBL451771401
CHEMBL540543601
CHEMBL457897301
CHEMBL376481601
CHEMBL572479801
CHEMBL557222901