Diagnostic efficacy of unconjugated plasma metanephrines for the detectionof pheochromocytoma

Citation
W. Raber et al., Diagnostic efficacy of unconjugated plasma metanephrines for the detectionof pheochromocytoma, ARCH IN MED, 160(19), 2000, pp. 2957-2963
Citations number
18
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
ARCHIVES OF INTERNAL MEDICINE
ISSN journal
00039926 → ACNP
Volume
160
Issue
19
Year of publication
2000
Pages
2957 - 2963
Database
ISI
SICI code
0003-9926(20001023)160:19<2957:DEOUPM>2.0.ZU;2-E
Abstract
Background: Recently, measurement of plasma metanephrines was suggested to improve the detection of pheochromocytoma compared with the other common bi ochemical tests. Objective: To examine the diagnostic precision of measurements of plasma me tanephrines, plasma catecholamines, and urinary catecholamines and to asses s their variability. Methods: Plasma metanephrine as well as plasma and urinary catecholamine co ncentrations were measured by high-performance liquid chromatography with e lectrochemical detection. Before surgery, responses of plasma metanephrines and catecholamines to change of posture were determined. Intraoperatively, metanephrines and catecholamines were measured before skin incision, durin g maximal mechanical tumor manipulation, and repetitively after the tumor w as separated from the circulation. Patients were reexamined 1 months after surgery. Patients with pheochromocytoma (n=17) and with histologically prov ed other adrenal tumors (n=14) were studied before, during, and after surge ry. Results: Measurement of plasma metanephrines and plasma and urinary catecho lamines provided 100% and 82% sensitivity, respectively, for the detection of pheochromocytoma (P<.001). Levels of plasma catecholamines but not metan ephrines increased in response to change of posture (norepinephrine, P=.03; epinephrine, P=.07) and intraoperative stress (norepinephrine, P=.002; epi nephrine, P=.009). Conclusions: Plasma metanephrines offer improved efficacy for the diagnosis of pheochromocytoma. Less variability in response to external factors may favor plasma metanephrines in the screening for this disease.