Incidentally vs nonincidentally diagnosed paragangliomas: Experience of a tertiary referral center

PURPOSE: Incidental detection of paragangliomas (PGLs) is increasing due to the increased use and advancements in imaging modalities. Therefore, its clinical presentation is changing. We aimed to compare the clinical characteristics of incidentally discovered PGLs with the clinically suspected. METHODS: We conducted a retrospective cohort study with patients diagnosed with PGLs between 2004 and 2023 at a tertiary referral center. Our cohort was divided into 2 groups: clinically suspected PGLs and incidentally discovered PGLs. Data on age, tumor location, size, symptoms, metastasis, and genetic testing were collected and compared between the groups. A subgroup analysis was conducted to evaluate adrenal and extra-adrenal PGLs separately. RESULTS: Of the 140 included patients, 64.3% were diagnosed incidentally and 35.7% through clinical suspicion. Incidentalomas were older at diagnosis (54.6±16.3 vs 46.2±16.5 years; p=0.002) and had smaller tumors (4.5±2.5cm vs 5.4±2.4cm; p=0.030). Clinically suspected cases were more likely to have metastatic disease (16.3% vs 3.5%; p=0.009) and exhibit classic symptoms, including palpitations (44.7% vs 8.4%; p<0.001), sweating (29.8% vs 7.2%; p<0.001), and headaches (29.8% vs 9.6%; p=0.003). In addition, sustained hypertension was more common in the clinically suspected group (68.8% vs 47.1%; p=0.016). In extra-adrenal PGLs, differences in tumor size and metastatic rates were more pronounced. Genetic testing showed a higher prevalence of mutations in the clinically suspected group (75% vs 47.6%; p=0.003). CONCLUSIONS: This study supports the shift in the predominant mode of paraganglioma presentation toward incidental findings. Enhanced recognition and proper follow up will refine the management of paragangliomas and ultimately improve patient outcomes.