{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T19:33:45Z","timestamp":1781811225237,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Malignant pheochromocytoma and paraganglioma (mPPGL) are not so common and the factors predicting the metastatic behavior are not well understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study included 218 patients with PPGL managed at our center over a period of 11 years (2013\u20132024). The clinical profile and treatment outcomes of patients with mPPGL were studied and were compared with non\u2010metastatic PPGL(non\u2010mPPGL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010six patients had mPPGL and the median age at diagnosis of metastases was 39.5 years(range 10\u201362). Twenty\u2010one(58.3%) patients had synchronous metastases and 15(41.7%) developed metachronous metastases after a median duration of 76 months(range 13\u2013270 months) from the diagnosis of the primary tumor. Metastases were detected in 100% of patients who had 18FDG(4\/4) and 68 Ga DOTATATE(4\/4) PET\u2010CT, 97.2% (35\/36) with CT\/MRI and 79.3%(23\/29) with 131I MIBG scan. Surgery was the primary treatment in 78%, and 131I MIBG therapy was administered to 19(52.8%) patients. Eleven patients succumbed due to metastatic disease and among them nine died within a year of diagnosis of metastases, the median survival at last follow\u2010up was 31.5 months (range 3\u201396). On comparing mPPGL(<jats:italic>n<\/jats:italic>\u2009=\u200936) and non\u2010mPPGL(<jats:italic>n<\/jats:italic>\u2009=\u2009182), we found that patients with mPPGL had larger tumors (8.8\u2009\u00b1\u20095.2 vs. 6.3\u2009\u00b1\u20093.3, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), had less frequent adrenergic symptoms and more often had extra\u2010adrenal tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Malignant PPGLs had a variable clinical course and were amenable to multimodal therapeutic strategies with a favorable outcome in about 67% of the patients. Although mPPGL had larger tumor diameter compared to non\u2010mPPGL, no particular size cut\u2010off could accurately predict metastases. Adjuvant 131I MIBG therapy is a useful treatment option in resource limited settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.70007","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:39:20Z","timestamp":1753868360000},"page":"480-486","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Profile, Outcomes, and Predictors of Malignant Pheochromocytoma and Paraganglioma: Insights From a Single\u2010Center Cohort"],"prefix":"10.1111","volume":"103","author":[{"given":"Devika","family":"Nandakumar","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4136-9843","authenticated-orcid":false,"given":"Remya","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rekha","family":"Pai","sequence":"additional","affiliation":[{"name":"Department of Molecular Pathology Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elanthenral","family":"Sigamani","sequence":"additional","affiliation":[{"name":"Department of Pathology Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihal","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Jebasingh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kripa","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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