{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:00:03Z","timestamp":1787238003517,"version":"build-2736575974"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to investigate sex differences in the management and outcomes of patients with pheochromocytomas and paragangliomas (PPGLs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort study including all patients diagnosed with PPGLs attending the Department of Endocrinology at Karolinska University Hospital between June 2005 and August 2024. The collected data included patient characteristics, biochemical, genetical, pharmacological and vital parameters noted during initial PPGL presentation and during follow-up, including survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 196 patients diagnosed with PPGLs (108 females and 88 males) were included. Paragangliomas were more prevalent in females than in males (23.1% vs 11.4%, P=0.04). Females required a lower final dose of preoperative phenoxybenzamine (50.8 \u00b1 19.8 vs 87.5 \u00b1 75.7 mg, P=0.04), while the final dose of preoperative doxazosin was non-significant lower (22.3 \u00b1 13.6 vs 26.0 \u00b1 13.9 mg, P=0.07). Moreover, females were less likely having laparoscopic surgery than males (55.2% vs 71.1%, P=0.03). After surgery, more females achieved remission from their type 2 diabetes compared to males (23.4% vs 11.8%, P=0.04). Despite similar age at diagnosis and similar follow-up time, no sex differences were identified in metastasis risk, blood pressure outcomes after surgery, or survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Females presented more often with paragangliomas which may explain why they were less likely to have laparoscopic surgery. Remission of type 2 diabetes occurred more commonly in females after surgery. Most other outcomes were similar between sexes. More research is needed to explore differences in outcomes between sexes in PPGLs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1597908","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T01:23:29Z","timestamp":1750037009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex differences in management and outcomes in pheochromocytomas and paragangliomas"],"prefix":"10.3389","volume":"16","author":[{"given":"M\u00e5ns A. J.","family":"Dahl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Calissendorff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Falhammar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1806651","article-title":"Pheochromocytoma and paraganglioma","volume":"381","author":"Neumann","year":"2019","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1530\/EC-17-0321","article-title":"Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center","volume":"7","author":"Falhammar","year":"2018","journal-title":"Endocr Connect"},{"key":"B4","doi-asserted-by":"publisher","first-page":"bvae005","DOI":"10.1210\/jendso\/bvae005","article-title":"Sex-related differences in self-reported symptoms at diagnosis in pheochromocytomas and paragangliomas","volume":"8","author":"Parisien-La Salle","year":"2024","journal-title":"J Endocr Soc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11906-018-0804-z","article-title":"Pheochromocytomas and hypertension","volume":"20","author":"Pappachan","year":"2018","journal-title":"Curr Hypertens Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.74.6.1290","article-title":"Assessment of the beta-adrenergic receptor pathway in the intact failing human heart: progressive receptor down-regulation and subsensitivity to agonist response","volume":"74","author":"Fowler","year":"1986","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-018-1734-x","article-title":"Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center","volume":"62","author":"Falhammar","year":"2018","journal-title":"Endocrine"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.3390\/jcm9082435","article-title":"Cardiovascular manifestations and complications of pheochromocytomas and paragangliomas","volume":"9","author":"Y-Hassan","year":"2020","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"917","DOI":"10.3390\/cancers14040917","article-title":"Pheochromocytomas and abdominal paragangliomas: A practical guidance","volume":"14","author":"Calissendorff","year":"2022","journal-title":"Cancers"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e198898","DOI":"10.1001\/jamanetworkopen.2019.8898","article-title":"Comparison of pheochromocytoma-specific morbidity and mortality among adults with bilateral pheochromocytomas undergoing total adrenalectomy vs cortical-sparing adrenalectomy","volume":"2","author":"Neumann","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002438","article-title":"Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension","volume":"38","author":"Lenders","year":"2020","journal-title":"J Hypertens"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-019-02035-3","article-title":"Pheochromocytoma- and paraganglioma-triggered Takotsubo syndrome","volume":"65","author":"Y-Hassan","year":"2019","journal-title":"Endocrine"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa982","article-title":"Metastatic pheochromocytomas and abdominal paragangliomas","volume":"106","author":"Granberg","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/EJE-16-0033","article-title":"European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma","volume":"174","author":"Plouin","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1463945","article-title":"Sex differences in presentation of pheochromocytoma and paraganglioma","volume":"16","author":"Ali","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s12020-008-9108-4","article-title":"Gender-related differences in the clinical presentation of Malignant and benign pheochromocytoma","volume":"34","author":"Lai","year":"2008","journal-title":"Endocr"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1210\/js.2019-00200","article-title":"Presentation, treatment, histology, and outcomes in adrenal medullary hyperplasia compared with pheochromocytoma","volume":"3","author":"Falhammar","year":"2019","journal-title":"J Endocr Soc"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa965","article-title":"Incidence and clinical presentation of pheochromocytoma and sympathetic paraganglioma: A population-based study","volume":"106","author":"Ebbehoj","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1530\/EJE-20-0628","article-title":"Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study","volume":"184","author":"Leung","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1998.tb04468.x","article-title":"The effects of gender on adrenergic receptor responsiveness","volume":"38","author":"Luzier","year":"1998","journal-title":"J Clin Pharmacol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/hr.2011.189","article-title":"Sex-related differences in pharmacokinetics and pharmacodynamics of anti-hypertensive drugs","volume":"35","author":"Ueno","year":"2012","journal-title":"Hypertens Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5701-6","article-title":"Resection of pheochromocytoma improves diabetes mellitus in the majority of patients","volume":"24","author":"Beninato","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.5173\/ceju.2014.04.art9","article-title":"The effect of surgical treatment of phaeochromocytoma on concomitant arterial hypertension and diabetes mellitus in a single\u2013centre retrospective study","volume":"67","author":"Pogorzelski","year":"2014","journal-title":"Cent Eur J Urol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-023-03492-7","article-title":"Secondary diabetes mellitus in pheochromocytomas and paragangliomas","volume":"82","author":"Moustaki","year":"2023","journal-title":"Endocrine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ando.2020.01.001","article-title":"Prevalence and progression of carbohydrate disorders in patients with pheochromocytoma\/paraganglioma: retrospective single-center study","volume":"81","author":"Elenkova","year":"2020","journal-title":"Annales d\u2019Endocrinol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab401","article-title":"Correlation between plasma catecholamines, weight, and diabetes in pheochromocytoma and paraganglioma","volume":"106","author":"Krumeich","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","first-page":"5153","DOI":"10.3390\/ijms24065153","article-title":"Pathophysiology and Management of Glycemic Alterations before and after Surgery for Pheochromocytoma and Paraganglioma","volume":"24","author":"Lopez","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/iju.2019.26.issue-2","article-title":"Incidence and predictive factors of hypoglycemia after pheochromocytoma resection","volume":"26","author":"Araki","year":"2019","journal-title":"Int J Urol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"48","DOI":"10.15605\/jafes.039.02.07","article-title":"Risk factors for perioperative complications, treatment outcomes and aggressive behavior of the tumor in patients with pheochromocytoma","volume":"39","author":"Narayanaswamy","year":"2024","journal-title":"J ASEAN Fed Endocr Soc"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.29.5.1133","article-title":"Tumor recurrence and hypertension persistence after successful pheochromocytoma operation","volume":"29","author":"Plouin","year":"1997","journal-title":"Hypertension"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.4158\/EP15725.OR","article-title":"Characteristics and outcomes of metastatic sdhb and sporadic pheochromocytoma\/paraganglioma: an national institutes of health study","volume":"22","author":"Turkova","year":"2016","journal-title":"Endocrine Pract"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-019-0339-y","article-title":"Predictors of recurrence of pheochromocytoma and paraganglioma: a multicenter study in Piedmont, Italy","volume":"43","author":"Parasiliti-Caprino","year":"2020","journal-title":"Hypertens Res"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-00992","article-title":"Malignant pheochromocytoma and paraganglioma: 272 patients over 55 years","volume":"102","author":"Hamidi","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad515","article-title":"Asymmetric adrenals: sexual dimorphism of adrenal tumors","volume":"109","author":"Bechmann","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B35","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1159\/000505788","article-title":"Adrenal tumors: are gender aspects relevant","volume":"36","author":"Alesina","year":"2020","journal-title":"Visceral Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e0168413","DOI":"10.1371\/journal.pone.0168413","article-title":"Disentangling of Malignancy from benign pheochromocytomas\/paragangliomas","volume":"11","author":"Kim","year":"2016","journal-title":"PloS One"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2890","DOI":"10.3390\/cancers15112890","article-title":"Long-term outcomes after surgery for pheochromocytoma and sympathetic paraganglioma","volume":"15","author":"Torresan","year":"2023","journal-title":"Cancers"},{"key":"B38","doi-asserted-by":"publisher","first-page":"zrac076","DOI":"10.1093\/bjsopen\/zrac076","article-title":"Long-term follow-up of patients undergoing laparoscopic surgery for phaeochromocytoma","volume":"6","author":"O\u2019Dwyer","year":"2022","journal-title":"BJS Open"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(24)00053-7","article-title":"Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021","volume":"9","author":"Patwardhan","year":"2024","journal-title":"Lancet Public Health"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1419028","article-title":"Metastatic disease and major adverse cardiovascular events preceding diagnosis are the main determinants of disease-specific survival of pheochromocytoma\/paraganglioma: long-term follow-up of 303 patients","volume":"15","author":"Raber","year":"2024","journal-title":"Front Endocrinol (Lausanne)"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1597908\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T01:23:30Z","timestamp":1750037010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1597908\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":40,"alternative-id":["10.3389\/fendo.2025.1597908"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1597908","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"article-number":"1597908"}}