A Five-Year Report on Experience in the Detection of Pheochromocytoma

Hernández, Francisco Cañizares; Sánchez, Maria Luisa Ortiz; Álvarez, Albert Alejandro Ávila; Díaz, José Carlos Losada; Pascual, Rosa Aurora Luezas; Pérez, M.; Tovar, I.; Martínez, Pedro Luis Moreno

doi:10.1016/s0009-9120(00)00172-7

Cited by 47 publications

(7 citation statements)

References 24 publications

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“…1995–2003 41 (20–73) 11,30 [ 21 ] FC Hernandez et al, 2000 University Hospital “Virgen de la Arrixaca”, Murcia, Spain. 1994–1998 57 42 (7–71) 34,23 [ 22 ] Laurence Amar et al, 2005 Referral to a Hypertension unit, France, 1975–2003 192 44 89,103 [ 24 ] K.C. Loh et al 1997 Endocrine clinics, Nova Scotia, Canada, 1986–1995 18 42 (12–81) 3,15 [ 25 ] Charles AG Proye et al, 1994 3 medical centers, France, 1951–1992 310 – – [ 26 ] P.F.…”

Section: Resultsmentioning

confidence: 99%

Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms

Soltani

Pourian

Davani

2016

J Diabetes Metab Disord

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ContextPheochromocytoma is a rare disease but with high mortality if it is not being diagnosed early. Several biochemical tests with high accuracy have been obtained, but the clinical threshold for request of these tests is not determined clearly.ObjectivesTo determine the Likelihood Ratios of clinical symptoms and signs in diagnosing pheochromocytoma. And also meta-analysis of their sensitivity in this disease.Data sourcesMEDLINE was searched for relevant English-language articles dated 1960 to February 2014. Bibliographies were searched to find additional articles.Study selectionWe included original studies describing the sensitivity and/or likelihood ratios of signs and symptoms in clinical suspicion of pheochromocytoma. Their method of diagnosis should have been based on pathology. We excluded specific subtypes or syndromes related to pheochromocytoma, or specific ages or gender. Also we excluded studies before 1993 (JNC5) which no definition of hypertension was presented. 37 articles were chosen finally.Data extractionTwo authors reviewed data from articles independently and gave discrepancies to third author for decision. The aim was extraction of raw numbers of patients having defined signs or symptoms, and draw 2 × 2 tables if data available. We meta-analyzed sensitivities by Statsdirect and Likelihood Ratios by Meta-disc soft wares. Because our data was heterogeneous based on I2 > 50 % (except negative Likelihood ratio of hypertension), we used random effect model for doing meta-analysis. We checked publication bias by drawing Funnel plot for each sign/symptom, and also Egger test.Data synthesisThe most prevalent signs and symptoms reported were hypertension (pooled sensitivity of 80.7 %), headache (pooled sensitivity of 60.4 %), palpitation (pooled sensitivity of 59.3 %) and diaphoresis (pooled sensitivity of 52.4 %). The definition of orthostatic hypotension was different among studies. The sensitivity was 23–50 %.Paroxysmal hypertension, chest pain, flushing, and weakness were the signs/symptoms which had publication bias based on Funnel plot and Egger test (P value < 0.05). Seven of the articles had control group, and could be used for calculating LR of signs/symptoms. Diaphoresis (LR+ 2.2, LR-0.45), Palpitation (LR+ 1.9, LR-0.52) and headache (LR+ 1.6, LR-0.24) were significant symptoms in clinical diagnosis of pheochromocytoma. Other signs and symptoms had been reported in only one study and could not have been meta-analyzed. Classic triad of headache, palpitation and diaphoresis in hypertensive patients had the LR+ 6.312 (95 % CI 0.217–183.217) and LR-0.139 (95 % CI 0.059–0.331). Surprisingly, hypertension was not important in clinical suspicion of pheochromocytoma, and even normotension increased the probability of the disease.ConclusionsBy available data, there is no single clinical finding that has significant value in diagnosis or excluding pheochromocytoma. Combination of certain symptoms, signs and para-clinical exams is more valuable for physicians. Further studies should be done, to specif...

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Section: Resultsmentioning

confidence: 99%

Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms

Soltani

Pourian

Davani

2016

J Diabetes Metab Disord

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“…This is useful since at low pretest prevalences, even with diagnostic specificity approaching 95%, posttest predictive values of a positive result for a single metabolite can be insufficient for reliable confirmation of a tumor. Although pretest prevalences of PPGLs can run up to 5% in patients with adrenal incidentalomas (23), among unselected patients screened for PPGLs pretest prevalences range from 0.8% to 1.6% (24, 25, 26), which is in line with lower prevalences of PPGLs among hypertensives of up to 0.6% (27). As we show here, at such prevalences posttest probabilities may not reach more than 10% for single positive results.…”

Section: Discussionmentioning

confidence: 77%

Plasma methoxytyramine: clinical utility with metanephrines for diagnosis of pheochromocytoma and paraganglioma

Rao

Peitzsch

Prejbisz

et al. 2017

European Journal of Endocrinology

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ContextMeasurements of plasma methoxytyramine, the O-methylated dopamine metabolite, are useful for detecting rare dopamine-producing pheochromocytomas and paragangliomas (PPGLs) and head and neck paragangliomas (HNPGLs), but utility for screening beyond that achieved using standard measurements of normetanephrine and metanephrine is unclear.ObjectiveEvaluation of the additional utility of methoxytyramine compared to plasma normetanephrine and metanephrine for diagnosis of PPGLs and HNPGLs.DesignComparative prospective study.MethodsComparison of mass spectrometric-based measurements of plasma methoxytyramine, normetanephrine and metanephrine in 1963 patients tested for PPGLs at six tertiary medical centers according to reference intervals verified in 423 normotensive and hypertensive volunteers.ResultsOf the screened patients, 213 had PPGLs and 38 HNPGLs. Using an upper cut-off of 0.10 nmol/L for methoxytyramine, 0.45 nmol/L for metanephrine and age-specific upper cut-offs for normetanephrine, diagnostic sensitivity with the addition of methoxytyramine increased from 97.2% to 98.6% for patients with PPGLs and from 22.1% to 50.0% for patients with HNPGLs, with a small decrease in specificity from 95.9% to 95.1%. Addition of methoxytyramine did not significantly alter areas under receiver operating characteristic curves for patients with PPGLs (0.984 vs 0.991), but did increase (P < 0.05) areas for patients with HNPGLs (0.627 vs 0.801). Addition of methoxytyramine also increased the proportion of patients with PPGLs who showed highly positive predictive elevations of multiple metabolites (70.9% vs 49.3%).ConclusionsWhile the benefit of additional measurements of plasma methoxytyramine for the detection of PPGLs is modest, the measurements do assist with positive confirmation of disease and are useful for the detection of HNPGLs.

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“…The 1999 Taiwanese survey by Lin et al [15]revealed that the most common cause of hypertension in infants was coarctation of the aorta, and in adolescents, systemic lupus nephritis. Pheochromocytoma constitutes only 1.4–2.9% of the causes of secondary hypertension in children [15, 16]. Since it is curable, however, it is important to consider it in the differential diagnosis of hypertensive children and to order the appropriate diagnostic tests, including serum renin and 24-hour urinary free catecholamines.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hemorrhage Caused by Pheochromocytoma in a Child

Chuang

Hsu²,

Lin³

et al. 2002

Pediatr Neurosurg

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We report a 6-year-old boy who presented with left occipital spontaneous lobar hematoma and hypertension. Cerebral angiography failed to demonstrate a vascular malformation. Subsequently, a left adrenal tumor was found that proved to be a pheochromocytoma. This is the first report in the literature of a lobar hematoma in a child caused by a concomitant pheochromocytoma. In children with hypertension and resulting intracerebral hematoma, a pheochromocytoma should be considered in the differential diagnosis.

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A Five-Year Report on Experience in the Detection of Pheochromocytoma

Cited by 47 publications

References 24 publications

Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms

Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms

Plasma methoxytyramine: clinical utility with metanephrines for diagnosis of pheochromocytoma and paraganglioma

Spontaneous Intracranial Hemorrhage Caused by Pheochromocytoma in a Child

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