8789 Unraveling Von Hippel Lindau Syndrome: A Comprehensive Analysis Of Clinical Manifestations, Age-Related Variations, And Tumor Prevalence In A Specialized Endocrine Center
Authors: Kumar Pasam Kiran , Gupta Yashdeep , Goyal Alpesh , Tandon Nikhil 
Published: October 2024

Abstract
Disclosure: K.K. Pasam: None. Y. Gupta: None. A. Goyal: None. N. Tandon: None.
Introduction: This study presents a thorough examination of Von Hippel Lindau (VHL) syndromes, focusing on the clinical spectrum and genetic mutations in our population. Methods: The study, conducted at the Department of Endocrinology and Metabolism from 2016 to 2022. Objectives included studying the spectrum of diseases in index patients and asymptomatic family members. Results: In our study, we identified 19 index cases and 12 asymptomatic cases identified on screening. The analysis of 31 VHL patients revealed a mean age of presentation of 24.2±11.1 years. Pancreatic cysts were the most common manifestation in 61% followed by pheochromocytoma in 54%, cerebellar hemangioblastomas in 45%, retinal angiomas in 39% and renal cell carcinoma in 35%. 16% of patients presented with nonfunctioning pancreatic neuroendocrine tumors, and one case featured an endolymphatic sac tumor.Pheochromocytomas in VHL syndrome presented at a remarkably young age, with an average of 23.1±11.4 years. Bilateral pheochromocytomas were observed in 14 (82%) and hormonal evaluation revealed urinary noradrenaline, normetanephrines, and plasma normetanephrine elevations of 5, 6, and 7-fold, respectively.The median size of pheochromocytomas in VHL syndrome was 5.4 cm. Metastatic pheochromocytoma was observed in one patient. Genetic analysis was available for 9 patients with most common mutation in exon 3 of chromosome 3. Discussion:The average age of VHL syndrome presentation in our cohort is younger than in other Indian studies. Males in our study were 45%, deviating from the absence of gender preponderance associated with VHL. Disparities in age of diagnosis and tumor prevalence compared with other international cohorts highlight potential regional and ethnic variations. Multiple pancreatic cysts in our study, with a prevalence of 61%, lower than the South Indian study's 71%. Literature comparisons indicate pancreatic cyst prevalence ranging from 42% to 51.6%. Cerebellar hemangioblastomas and retinal angiomas, typical VHL lesions, displayed prevalence rates of 45% and 39%, respectively.Pheochromocytoma, the second most common tumor in our cohort (54%), exhibited variations in prevalence compared to international studies. Higher rates reported by Fagundes et al. and Dwivedi et al. from Brazil might be attributed to recruitment biases from endocrine centers.The average age of VHL-associated pheochromocytoma presentation in our study contrasts with MEN2, emphasizing the unique features of VHL. Our study, reporting a 16% prevalence of PNETs, aligns with Binderup et al. The mean age of presentation for VHL-associated PNETs (20.8 ± 3.63 years) contrasts with Western literature, suggesting potential ethnic differences. Conclusion: Our study contributes to a nuanced understanding of VHL syndrome, shedding light on age-related variations, gender distribution, and tumor prevalence.
Presentation: 6/2/2024