Loss of heterozygosity on the wild-type allele is also detected in the tumors of patients with germline missense mutations in MAX. Although metastatic PHEOs are rare, except in patients carrying SDHB mutations, Mendez found that approximately 37% of patients with MAX mutations present with metastases at diagnosis [21]; this suggests MAX mutations may be risk factors for metastatic disease. Here, MAX is linked to metastatic neoplasm.