Lessons from an unpleasant surprise: a biochemical strategy for the diagnosis of pheochromocytoma

Gardet, Véronique; Gatta, Blandine; Simonnet, Guy; Tabarin, Antoine; Chêne, Geneviève; Ducassou, D.; Corcuff, Jean-Benoı̂t

doi:10.1097/00004872-200106000-00006

Cited by 57 publications

(37 citation statements)

References 20 publications

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“…It confirms, if needed, that urine assays are sound methods for this purpose (8,10,11,12,13,15,17,18,20). This study also confirms a clear usefulness of plasma assays in a major clinical centre as already demonstrated (10,11,12,13,15,17,18).…”

Section: Discussionsupporting

confidence: 82%

“…Total uNMA and uMA were extracted on cationic and anionic columns (Bio-Rad) (8). pNMA and pMA assays were based on a published method (19).…”

Section: Methodsmentioning

confidence: 99%

“…Patients from other departments were not included. The population in which the diagnosis of phaeochromocytoma was questioned resembled the one previously reported (8). It included patients referred for high blood pressure, which did not respond to the usual treatments (chronic as well as acute hypertension) including subjects in the emergency department of cardiology, non-specific signs of phaeochromocytoma (spells, sweating, palpitations, etc.…”

Section: Subjectsmentioning

confidence: 99%

“…The improvement upon considering individual analytes is indeed especially noticeable on the specificity attached to 100% sensitivity. We used to routinely propose a graphical approach for urine total MA (NMA and MA axis) (8). A very similar graph can be drawn for plasma-free MA (16).…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…About 12 years ago, our laboratory established local reference ranges for urinary analytes used for the diagnosis of phaeochromocytoma of patients investigated in cardiology and endocrinology departments (8). This first study was used i) to phase out obsolete assays such as photometric methods or systematic vanilmandelic assay and ii) to re-organise HPLC-ED assays to obtain fast production of results of urinary normetanephrine (uNMA) and urinary metanephrine (uMA) assays.…”

Section: Introductionmentioning

confidence: 99%

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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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