INTERPRETATION OF RANDOM URINARY CATECHOLAMINES AND THEIR METABOLITESIN NEUROBLASTOMA

This study reports experience in the estimation of urinary catecholami nes (uCATs) and their metabolites in the diagnosis and follow-up of ne uroblastoma. Random urine samples were assayed for dopamine, noradrena line and adrenaline, together with their metabolites 4-hydroxy 3-metho xymandelic acid (HMMA) and homovanillic acid (HVA), using HPLC with el ectrochemical detection. Twenty of 21 patients had elevation of one or more uCATs metabolites at diagnosis. Patients were monitored serially from diagnosis and, in those patients who had delayed resection of pr imary tumour (n = 13), particular attention was paid to levels at the pre-surgical evaluation as an indicator of persistence of viable disea se at the time of surgery; dopamine proved to be the most accurate ind icator of persistent disease at this time. Five of these patients deve loped recurrent disease, 4 of whom had elevation of two or more uCATs metabolites at the time of relapse. Several conclusions can be drawn f rom this study: (a) results for HMMA, HVA and dopamine in random urine samples will detect all but the most biochemically immature or inert tumours; (b) dopamine may be the most reliable indicator of persistent disease and (c) noradrenaline and adrenaline measurements were of lit tle benefit. As results are expressed in relation to urinary creatinin e, excretion of which may be affected by dietary protein and is theref ore not constant, borderline results should be repeated.