While metabolic adaptations are mostly seen as a consequence of carcinogenesis, it has been unequivocally established that metabolic alterations can also cause cancer, examples being mutations in genes encoding succinate dehydrogenase (SDH, pheochromocytoma and paraganglioma), fumarate hydratase (FH, papillary renal cancers) and isocitrate dehydrogenase 1 and 2 (IDH1/2, among others acute myeloid leukemia and gliomas)31–37. The gene discussed is FH; the disease is hereditary pheochromocytoma-paraganglioma.