Clonidine-suppression test in epinephrine secreting pheochromocytoma: report of a case

Dupont, Alain; Vanderniepen, P.; Gerlo, Erik; Somers, Guido; Vanhaelst, L.; Veld, Peter In’t; Gepts, W; Sacré, Robert; Six, Roland

doi:10.1007/bf03350673

J Endocrinol Invest

1985

DOI: 10.1007/bf03350673

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Clonidine-suppression test in epinephrine secreting pheochromocytoma: report of a case

Alain Dupont

P. Vanderniepen

Erik Gerlo³

et al.

Abstract: A patient is described in whom the diagnosis of pheochromocytoma was suspected on clinical grounds. He had normal urinary and plasma norepinephrine levels, with normal suppression of plasma norepinephrine by clonidine. However, plasma and urinary epinephrine levels were above normal, and plasma epinephrine was not suppressed but increased by clonidine. Selective venous sampling showed marked unilateral adrenal epinephrine excess. A large epinephrine secreting pheochromocytoma was surgically removed. This case … Show more

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1987

1991

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Cited by 12 publications

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“…* 29 Most studies have considered the clonidine test to be positive (abnormal) when the sum of plasma NE and EPI levels fails to decrease below 2.96 nmol/1, regardless of the baseline levels. Using this criterion, we also found that the test was not sensitive enough, since in five of 30 patients with pheo the test was negative.…”

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Glucagon and clonidine testing in the diagnosis of pheochromocytoma.

et al. 1991

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We assessed the sensitivity and specificity of glucagon stimulation and clonidine suppression tests in the diagnosis of pheochromocytoma in 113 hypertensive patients, 39 with and 74 without the tumor. In the glucagon stimulation test, blood was sampled 2 minutes after intravenous injection of 0.28 fimol (1 mg) glucagon, and in the clonidine suppression test, blood was sampled 3 hours after administration of oral clonidine, 130 /imol (0-3 mg)/70 kg body wt Baseline levels of catechols in antecubital venous blood were abnormal, with norepinephrine greater than 7.10 nmol/1 (1,200 pg/m), epinephrine greater than 1.51 nmol/1 (276 pg/ml), norepinephrine/dihydroxyphenylglycol (DHPG) ratio greater than 1.09, or dopa greater than 35.53 nmol/1 (7,000 pg/ml), in 30 of 39 patients with pheochromocytoma (sensitivity 77%) and 1 of 74 patients without pheochromocytoma (specificity 99%). Results of the glucagon test were abnormal (norepinephrine greater than 11.83 nmol/1 [2,000 pg/ml] or more than threefold increase from baseline) in 25 of 31 patients with pheochromocytoma (sensitivity 81%) and 0 of 72 patients without pheochromocytoma (specificity 100%). Results of the clonidine test were abnormal (after clonidine norepinephrine greater than 2.96 nmol/1 [500 pg/ml] or less than 50% decrease from baseline) in 29 of 30 patients with pheochromocytoma (sensitivity 97%) and in 7 of 30 patients without pheochromocytoma (specificity 67%). Very high baseline levels of catechols therefore indicated the presence of pheochromocytoma, but there were several false-negative results when normal levels were obtained. The glucagon test alone was highly specific but not sensitive, and the clonidine test was highly sensitive but less specific. Of 50 patients undergoing both glucagon stimulation and clonidine suppression tests, the results of at least one test were abnormal in 22 of 22 patients with pheochromocytoma (sensitivity 100%) and in 6 of 28 patients without pheochromocytoma (specificity 79%). When both tests were negative, the diagnosis could be excluded, and the results were conclusive in 80% of the patients. Combined glucagon stimulation and clonidine suppression testing is worthwhile in the diagnosis of pheochromocytoma by blood tests. (Hypertension 1991;17:733-741) P heochromocytoma (pheo) is a rare but important cause of clinical hypertension. The tumor often is curable, and if undiagnosed, it can lead to fatal complications. Because of the much greater prevalence of hypertension from other causes and the nonspecificity of symptoms and signs of pheo, the diagnosis is based on biochemical evidence of excessive release of catecholamines. 1 * 2 Diagnostic evaluation of hypertensive patients where pheo is considered often includes measurements of urinary excretion or plasma levels of catecbolamines or catecholamine metabolites. Recently, it was reported that rates of urinary excretion of norepinephrine (NE) and of its intraneuronal metab-

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confidence: 99%

“…Using this criterion, we also found that the test was not sensitive enough, since in five of 30 patients with pheo the test was negative. Dupont et al 29 reported a patient with an EPIsecreting pheo in whom plasma NE levels were suppressed normally after clonidine administration. One of our patients with a normal clonidine test also had an EPI-secreting tumor.…”

mentioning

confidence: 99%

Glucagon and clonidine testing in the diagnosis of pheochromocytoma.

et al. 1991

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Evaluation of the clonidine-suppression test in the diagnosis of pheochromocytoma

Plewe¹,

Krause²,

Cordes³

et al. 1988

Klin Wochenschr

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In this study we examined the preoperative value of the clonidine-suppression test in 15 patients with surgically proved pheochromocytomas. The result of the clonidine-suppression test was pathological (epinephrine plus norepinephrine above 500 ng/l 3 h after clonidine) in 10 of 15 patients (66%). These patients had relatively large tumors and higher basal norepinephrine plasma levels. Out of the 5 cases without a pathological clonidine test 4 had normal basal plasma catecholamine levels with the result that the clonidine test could not be properly applied and 1 case produced a false negative result. These 5 cases generally had smaller tumors and lower plasma catecholamine levels. Two of these cases had basally raised epinephrine values. The other three cases had either a paradoxical increase or a suspiciously low fall (less than 25%) in norepinephrine within the normal range. We conclude that the clonidine-suppression test is only reliable for the diagnosis of relatively large pheochromocytomas.

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Usefulness of basal catecholamine plasma levels and clonidine suppression test in the diagnosis of pheochromocytoma

Mannelli¹,

Feo

Maggi

et al. 1987

J Endocrinol Invest

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In the present paper we report our experience on the utility of basal plasma catecholamine (CA) measurement and of the clonidine-suppression test in the diagnosis of pheochromocytoma. Basal noradrenaline (NA) and adrenaline (A) were assayed in plasma samples of 27 subjects affected by pheochromocytoma. When compared to basal values obtained in hypertensive patients without pheochromocytoma, one or both the CA resulted pathologically elevated in all patients except one. The response to the clonidine-suppression test was evaluated in 41 hypertensive patients suspected of having a pheochromocytoma measuring plasma NA and A in basal conditions and 2 and 3 h after oral administration of 300 micrograms clonidine. Extensive laboratory and instrumental findings confirmed the presence of pheochromocytoma only in 12 patients. Among the other 29 patients basal plasma CA resulted higher than normal in 4 patients. In patients without pheochromocytoma clonidine induced a significant fall in both NA and A plasma levels. The decrease in NA was observed in each patient. The 12 patients with pheochromocytoma showed a pathological elevation of one or both the CA. In this group clonidine did not significantly suppress plasma CA. The individual responses were extremely variable. Our data confirm the validity of plasma CA measurement as a diagnostic tool for the diagnosis of pheochromocytoma. The results of the clonidine-suppression test were generally confirmatory of the basal CA plasma values but in the 4 hypertensive patients without pheochromocytoma who showed basal plasma CA higher than normal clonidine resulted a useful tool in excluding the presence of pheochromocytoma.

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Clonidine-suppression test in epinephrine secreting pheochromocytoma: report of a case

Cited by 12 publications

References 15 publications

Glucagon and clonidine testing in the diagnosis of pheochromocytoma.

Glucagon and clonidine testing in the diagnosis of pheochromocytoma.

Evaluation of the clonidine-suppression test in the diagnosis of pheochromocytoma

Usefulness of basal catecholamine plasma levels and clonidine suppression test in the diagnosis of pheochromocytoma

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