Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass

Unger, Nicole; Pitt, Christian; Schmidt, Ingo; Walz, Martin K.; Schmid, Kurt Werner; Philipp, Thomas; Mann, Klaus; Petersenn, Stephan

doi:10.1530/eje.1.02097

Cited by 128 publications

(86 citation statements)

References 16 publications

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“…As with Sawka et al (40) we found a better mean specificity with urinary assays (98.2%, range from 96.9 to 100%) than with plasma ones (93.6%, range from 89.7 to 98.6%). This is valuable for the detection of pheochromocytomas in a sporadic context, where the best possible specificity is required.…”

Section: Controls (Nz71)supporting

confidence: 89%

An analysis of the biochemical diagnosis of 66 pheochromocytomas

d’Herbomez¹,

Forzy

Bauters

et al. 2007

eur j endocrinol

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Objectives: The aims of this study were to determine the performance of each variable, to define the optimal diagnostic thresholds and to determine the relative value of assaying chromogranin A (CgA). Design: Prospective study. Methods: Two groups of patients were studied: a control group of 71 patients and a group of 63 patients with a histologically-proven pheochromocytoma (52 pheochromocytomas and 14 paragangliomas). Fourteen of the patients had a family history of the disease. Eleven variables were assayed in each patient, i.e. the plasma and urinary concentrations of amines and their derivatives, and the CgA serum concentration.Results: The study of the control group showed that all the serum assays gave false positive results (from 6 to 23%), as did four of the six urinary assays (from 2.9 to 12.3%). The areas under the receiver operating characteristic curves varied from 0.689 to 0.992. The variables relating to the epinephrine pathway were significantly less expressed in the hereditary diseases than in the sporadic cases. The diagnostic thresholds of the three most efficient variables have been raised. Conclusions: Plasma determinations of metanephrines are now an easy and convenient tool for the diagnosis of pheochromocytoma. However, in our study the best specificity was obtained with the urinary tests rather than with the plasma assays while the highest sensitivities were for the normetanephrine assays. The assay of CgA was highly efficient in diagnosing pheochromocytomas in the absence of renal insufficiency. By combining it with fractionated metanephrine assays, the sensitivities of the latter were increased.European Journal of Endocrinology 156 569-575

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Section: Controls (Nz71)supporting

confidence: 89%

An analysis of the biochemical diagnosis of 66 pheochromocytomas

d’Herbomez¹,

Forzy

Bauters

et al. 2007

eur j endocrinol

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“…This compares with previously reported diagnostic specificities for plasma free metanephrines measured by LCEC at the same center of 85 % [9], and at the NIH of 89 % [8]. In further contrast, for plasma free metanephrines measured by RIA, the diagnostic specificity was 79 % [10].…”

Section: Future Challenges For Effective Diagnosissupporting

confidence: 65%

“…Plasma free metanephrines showed superior combined diagnostic sensitivity and specificity over all other tests examined, including urinary and plasma catecholamines, urinary vanillylmandelic acid and urinary total and fractionated metanephrines. The high diagnostic sensitivity of measurements of plasma free metanephrines has now been independently confirmed by 4 other groups of investigators [7,[9][10][11]. All together, the five independent studies -with 336 patients with pheochromocytoma and close to 2 500 patients in whom the tumor was excluded -have indicated an overall diagnostic sensitivity of 98 % and specificity of 92 % for measurements of plasma free metanephrines (Table 1).…”

Section: Current Progress In Diagnosismentioning

confidence: 64%

“…Correct understanding of the pathways of catecholamine metabolism has provided a rationale for many subsequent studies examining the utility of measurements of plasma free metanephrines for diagnosis of pheochromocytoma [5][6][7][8][9][10][11]. At the NIH, the superiority of plasma free metanephrines over other tests was established in a series of 3 published reports [5,6,8], culminating in a study involving over 850 patients, including 214 with pheochromocytoma [8].…”

Section: Current Progress In Diagnosismentioning

confidence: 99%

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Current Progress and Future Challenges in the Biochemical Diagnosis and Treatment of Pheochromocytomas and Paragangliomas

Eisenhofer¹,

Siegert²,

Kotzerke³

et al. 2008

Horm Metab Res

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Findings from five independent studies -with close to 350 patients with pheochromocytoma and more than 2 500 in whom the tumor was excluded -indicate that measurements of plasma free metanephrines provide an overall diagnostic sensitivity of 98 % and specificity of 92 %. The recommendation that initial testing for the tumor should always include measurements of either plasma or urinary fractionated metanephrines results from recognition of the high diagnostic sensitivity of measurements of plasma metanephrines. The few patients with pheochromocytoma in whom the test may not yield a positive result include those with very small tumors or microscopic disease and others with tumors that do not produce norepinephrine and epinephrine. Such patients are typically normotensive and do not exhibit symptoms of catecholamine excess. Additional measurements of methoxytyramine can be useful for detecting those tumors that produce only dopamine. Suboptimal diagnostic specificity and difficulties in distinguishing truefrom false-positive elevations of plasma metanephrines remain challenges for diagnosis. Improvements in analytical technology (e.g., liquid chromatography with tandem mass spectrometry) and new strategies for follow-up testing provide possible solutions to these problems. The single most important remaining clinical care challenge is the development of effective cures for patients with malignant disease. Current treatments, none of which are truly satisfactory, include chemotherapy and radiopharmaceutical therapy with 131 I-labelled miodobenzylguanidine or radioactive somatostatin analogues. Improvements in treatment may in the future come from several fronts, but proof of efficacy ideally will require well-coordinated multicenter prospective trials in larger numbers of patients than in previous studies.

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“…Some papers have reported a superiority of plasma-free MA assay compared with urine total MA assay (21,30). This study also follows this trend.…”

Section: Clinical Considerationssupporting

confidence: 79%

Phasing-in plasma metanephrines determination

Brossaud¹,

Gosse²,

Gatta³

et al. 2013

European Journal of Endocrinology

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Objectives: We set up plasma normetanephrine (pNMA) and metanephrine (pMA) assays as they demonstrated their usefulness for diagnosing phaeochromocytomas. Our scope is to describe some practical laboratory aspects and the clinical relevance of these assays in our endocrinological or cardiological departments. Methods: We retrospectively reviewed the results of MA from a population of in-and outpatients over a 7-year period. Subjects (nZ2536) from endocrinological or cardiological departments were investigated (66 phaeochromocytomas). Urinary NMA (uNMA) and pNMA, and urinary MA (uMA) and pMA were assayed by HPLC with electrochemical detection. Results: pNMA and pMA assays are now more frequently requested than uNMA and uMA. This changed our laboratory work load with improved delivery, sensitivity and reliability of plasma assays as well as reduced apparatus maintenance time. The pNMA and pMA upper reference limits (URLs) of subjects with no phaeochromocytoma were 1040 and 430 pmol/l respectively. Sensitivity and specificity based on receiver operating characteristic curves optimal points were 83 and 93% for pNMA at 972 pmol/l and 67 and 98% for pMA at 638 pmol/l. Sensitivity and specificity of paired tests of pMA (positive test: at least one analyte above its URLs) were 100 and 91% respectively. Conclusion: The very low concentration of analytes requires a sustained very good apparatus analytical sensitivity. This can be obtained in an up-to-date laboratory. In terms of clinical performances, assays in plasma or urine are equivalent. Depending on local preferences, populations, strategies or departments, requests for one or the other assay may sustain the need for specifically defined reference ranges.

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Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass

Cited by 128 publications

References 16 publications

An analysis of the biochemical diagnosis of 66 pheochromocytomas

An analysis of the biochemical diagnosis of 66 pheochromocytomas

Current Progress and Future Challenges in the Biochemical Diagnosis and Treatment of Pheochromocytomas and Paragangliomas

Phasing-in plasma metanephrines determination

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