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2015 ; 132
(ä): 139-56
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Von Hippel-Lindau disease
#MMPMID26564077
Chittiboina P
; Lonser RR
Handb Clin Neurol
2015[]; 132
(ä): 139-56
PMID26564077
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von Hippel-Lindau (VHL) disease is an inheritable condition with an incidence of
1 in 36000 live births. Individuals with VHL develop benign and malignant tumors
including retinal and central nervous system hemangioblastomas, clear cell renal
cell carcinomas (RCC), pheochromocytomas, pancreatic neuroendocrine tumors and
endolymphatic sac tumors (ELSTs). VHL is caused by germline loss of function of
the VHL gene on one allele at chromosome 3p25-26. A somatic "second hit" event
leads to the loss of the other allele and tumor formation. Loss of VHL function
in cells leads to increased expression and stabilization of hypoxia inducible
factor (HIF). VHL protein/HIF pathway has been implicated in tumorigenesis for
hemangioblastomas, RCC and other VHL tumors. Clinical examination, imaging, and
genetic testing for VHL mutations confirm VHL disease. Management of VHL disease
largely consists of surgical resection of symptomatic tumors (hemangioblastomas),
tumors prone to metastasize (RCC larger than 3cm), or tumors causing hormonal
symptoms (pheochromocytomas). Despite advances in early diagnosis and management
of VHL disease, life expectancy for VHL patients remains low at 40-52 years.
Secondary effects from VHL manifestations are mitigated by routine surveillance
and early detection. In this chapter, we summarize the current state of knowledge
in VHL disease.