Evaluation of urinary metanephrines for the diagnosis of pheochromocytoma.

##plugins.themes.academic_pro.article.sidebar##

Published Jan 17, 2014
Download
pdf
Vol. 91 No. 12 (2013): Issue Dec 2013

##plugins.themes.academic_pro.article.main##

A. Bachali Belhadj
A. Bachali Belhadj
E. Chérif Miladi
S. Bahri
A. Chaabane
H. Lamouchi
K. Khiari
N. Khalfallah
S. Ben Ammar

Abstract

Objective: evaluate the assay of urinary metanephrines in diagnosis of pheochromocytoma (PH) and determine diagnostic cut-off values.
methods: this is a retrospective study about 87 patients suspected of pheochromocytoma,whose of  24-h urinary fractionated
metanephrine was measured. These cases were collected from Internal Medecine Departments (A and B) at Charles Nicolle’s Hospital. Two groups of patients were studied: a pheochromocytoma group (n=33) with a histologically-proven pheochromocytoma and a control group of 54 patients. Receiver Operating Characteristic (ROC) curves were used to determine the best sensitivities and specificities.
results: The analysis of biological parameters showed that means and standard deviation of urinary fractionated metanephrines in pheochromocytoma group were significantly higher than those of control group. Sensitivity and specificity of urinary normetanephrine test (95% and 98.1% respectively) were higher than those of urinary metanephrine and 3-methoxytyramine. A correlation between urinary normetanephrine and tumor size of pheochromocytoma was found.
Conclusion: Urinary fractionated metanephrines is an efficient biochemical test for the diagnosis of pheochromocytoma.

Keywords:

pheochromocytoma, catecholamines, Metanephrine, normetanephrine, 3-methoxytyramine

##plugins.themes.academic_pro.article.details##

References

  1. Lenders J.W, Eisenhofer G, Manelli M et al. Pheochromocytoma. Lancet 2005; 366: 665-675.
  2. Pacak K, Linehan M, Eisenhofer G et al. Recent advances in genetics, diagnosis, localization and treatment of pheochromocytoma. Ann. Intern. Med 2001; 134:315-329.
  3. Peyrin L. Le diagnostic du phéochromocytome atypique: un challenge aussi pour le biologiste. Pathol Biol 2001; 49:247-54.
  4. O'Riordain DS, Young Jr WF, Grant CS et al. Clinical spectrum and outcome of functional extraadrenal paraganglioma. World J Surg 1996; 20:916-921.
  5. Neumann HP, Berger DP, Sigmund D et al. Pheochromocytomas, multiple endocrine neoplasia type 2, and von Hippel-Lindau disease. N Engl J Med 1993;329:1531-1538.
  6. Mannelli M, Ianni L, Cilotti A et al. Pheochromocytoma in Italy: a multicentric retrospective study. Eur J Endocrinol 1999; 141:619- 624.
  7. Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev 2003; 24:539-553.
  8. William F, Young Jr. Pheochromocytoma: 1926-1993. TEM 1993; 4:122-7.
  9. Watkins DB. Pheochromocytoma: a review of the literature. J Chron Dis 1957; 6:510-27.
  10. Ortega P Jr. Malignant paraganglioma arising from the organ of Zuckerkandl; report of a case with autopsy observations. AMA Arch Path 1952; 53:78-86.
  11. d'Herbomez, Forzy G, Bauters C et al. An analysis of the biochemical diagnosis of 66 pheochromocytomas. Eur J Endocrinol 2007; 156: 569-575.
  12. Pacak K, Eisenhofer G, Ahlman H et al. International symposium on pheochromocytoma. Pheochromocytoma: recommendations for clinical practice from the First International Symposium 2005. Nat Clin Pract Endocrinol Metab 2007; 3:92-102.
  13. Sawka AM, Jaeschke R, Singh RJ et al. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. Journal of Clinical Endocrinology and Metabolism 2003; 88:553-558.
  14. Unger N, Pitt C, Schmidt IL et al. Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. European Journal of Endocrinology 2006; 154:409-417.
  15. d'Herbomez M, Rouaix N, Forzy G et al. Diagnostic biologique de 55 phéochromocytomes et / ou paragangliomes. Annales d'Endocrinologie 2005; 66:436.
  16. Fitzgerald P & Goldfren A. Adrenal medulla. In Basic and Clinical Endocrinology 2004; 7:439-477.
  17. Eisenhoher G, Keiser H, Friberg P. Plasma Metanephrines Are Markers of Pheochromocytoma Produced by Catechol-OMethyltransferase Within Tumors. JCE & M 1998; 83:2175-2185.
  18. Eisenhofer G, Goldstein DS, Sullivan P et al. Biochemical and clinical manifestations of dopamine-producing paragangliomas: utility of plasma methoxytyramine. Journal of Clinical Endocrinology and Metabolism 2005; 90:2068-2075.
  19. Lefebvre H. Les pseudophéochromocytomes médicamenteux. Mt Endocrinologie 2002; 4:149-155.
  20. Lenders JW, Pacak K, Walther MM et al. Biochemical diagnosis of pheochromocytoma: Which test is best? JAMA 2002; 287:1427-1434.
  21. Hernandez FC, Sanchez M, Alvarez A et al. A five-year report on experience in the detection of pheochromocytoma. Clin Biochem 2000; 33:649-655.
  22. Unger N,Hinrichs J, Deutschbein T et al. Plasma and Urinary Metanephrines Determined by an Enzyme Immunoassay, but not Serum Chromogranin A for the Diagnosis of Pheochromocytoma in Patients with Adrenal Mass. Exp Clin Endocrinol diabetes 2012; 120:494-500.
  23. Eisenhofer G, Golstein D, Walther M et al. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results? J Clin Endocrinol Metab 2003; 88:2656-66.
  24. Proye C. Aspects modernes de la prise en charge des phéochromocytomes et des paragangliomes abdominopelviens. Ann Chir 1998; 52:643-56.
  25. D'Herbomez M, Rouaix N,Bauters C et al. Diagnostic biologique des phéochromocytomes et paragangliomes. La Presse Médicale 2009; 38:927- 934.
  26. Col V, De Canniere L, Collard E et al. Laparoscopic adrenalectomy for phaechromocytoma: endocrinological and surgical aspects of a new therapeutic approach. Clin Endocrinol1999; 50:121-5.
  27. Brown MJ, Allison DJ, Jenner DA et al. Increased sensitivity and accuracy of pheochromocytoma diagnosis achieved by use of plasma-adrenaline estimation and a pentolinium-suppression test. Lancet 1981; 24:174-7.