Drugs currently received were however reviewed, and a possible drug interaction with measurement of metanephrines was found. Objectives: To establish the sensitivity and specificity of plasma-free metanephrine (fMN) and free normetanephrine (fNMN) concentrations to diagnose pheochromocytoma in dogs. In the recommendations for the diagnosis of pheochromocytoma from the First International Symposium on pheochromocytoma, the authors stated that ‘measurements of fractionated metanephrines (i.e. Clinical, biochemical, and radiological characteristics of a … Kumar RM, Violette PD, Tran C, Tomiak E, Izard J, Bathini V, Rowe NE. Results Patient characteristics In this study, 964 patients were selected from September 2013 to March 2015. Tests for plasma catecholamines yielded eight false-negative results and a sensitivity of 85% (44 of 52 patients [CI, 72% to 93%]). Due to its high sensitivity, the assessment of plasma free metanephrines is a powerful method to rule out the diagnosis of pheochromocytoma in highly suspicious cases. Crossref Medline Google Scholar; 19. In … Please enable it to take advantage of the complete set of features! Raber W, Kotal H, Marculescu R, Scheuba C, Niederle MB, Kautzky-Willer A, Krebs M. J Clin Med. Tests for plasma metanephrines are more sensitive than tests for plasma catecholamines or urinary metanephrines for the diagnosis of pheochromocytoma. In a group of 63patients with histologically-proven pheochromocytoma (52PHEO and Measurement of plasma metanephrines has been shown to be a highly sensitive test for the detection of phaeochromocytoma; a negative test result virtually rules out the diagnosis. 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 , 120 ( 2012 ) , pp. 2002 Sep;970:29-40. doi: 10.1111/j.1749-6632.2002.tb04410.x. This case illustrates the superiority of plasma levels of free (unconjugated) metanephrines, compared with other biochemical tests, to detect pheochromocytoma. Conclusion Plasma free metanephrines provide the best test for excluding or confirming pheochromocytoma and should be the test of first choice for diagnosis of the tumor. Epub 2018 Aug 23. Procopiou M, Finney H, Akker SA, Chew SL, Drake WM, Burrin J, Grossman AB. Epub 2011 Oct 24. ELETRIPTAN (RELPAXA™) CAUSING FALSE POSITIVE ELEVATIONS IN URINARY METANEPHRINES. If the results are equivocal then we perform the clonidine test. 5,6 Pheochromocytomas were associated with increases in plasma concentrations of metanephrines that were greater and more consistent than those in plasma catecholamine concentrations. Laboratory testing showed high total plasma metanephrines: 890 pg/ml (< or = 205), 24-hour urine metanephrines: 2337 (140–785), A1C: 10%. Eur J Endocrinol. Results: More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. As described elsewhere (4), findings of plasma levels of normetanephrine less than 112 ng/liter (0.61 nmol/liter) and of metanephrine Most reference laboratories have standardized their 24-hour fractionated metanephrine assays on the basis of healthy Boyd J, Leung AA, Sadrzadeh HS, Pamporaki C, Pacak K, Deutschbein T, Fliedner S, Kline GA. Eur J Endocrinol. Careers. A plasma test is much simpler to collect than a 24-hour urine specimen and is more suitable in children and in patients with renal insufficiency. Overnight excretion of urinary catecholamines and metabolites in the detection of pheochromocytoma. Animals: Forty-five client-owned dogs (8 dogs with pheochromocytoma… Unable to load your collection due to an error, Unable to load your delegates due to an error. 2011 Dec;71(8):695-700. doi: 10.3109/00365513.2011.622410. Less variability in response to external factors may favor plasma metanephrines in the screening for this disease. Another caution on biochemical testing relates to the refer-ence range for 24-hour urinary fractionated metanephrines. Her plasma normetanephrine level was 651 pg per milliliter (reference range, 0 to 145) — greater than four times the upper reference limit — which is reported to have a very high positive predictive value and 100% specificity for biochemically active pheochromocytoma and paraganglioma 2 (see the Supplementary Appendix, available with the full text of this letter at NEJM.org). 6). A high rate of modestly elevated plasma normetanephrine in a population referred for suspected PPGL when measured in a seated position. 2019 Dec;13(12):372-376. doi: 10.5489/cuaj.6254. Measurement of fractionated plasma metanephrines is the best initial test for excluding pheochromocytoma. 2006, Pamporaki et al. The capacity of Plasma concentrations of metanephrines and catecholamines were pheochromocytomas to produce free metanephrines was examined in six pheochromocytoma patients with a positive test result further examined from measurements of COMT enzyme to glucagon (i.e. Patients with pheochromocytoma may also be asymptomatic and present with sustained hypertension or an incidentally discovered adrenal mass. normetanephrine and metanephrine measured separately) in urine or plasma provide superior diagnostic sensitivity to measurements of the parent catecholamines’ . Curr Hypertens Rep. 2002 Jun;4(3):250-5. doi: 10.1007/s11906-002-0015-4. More recent developments in the biochemical diagnosis of pheochromocytoma include liquid chromatographic measurements of plasma-free metanephrines, the single largest source of which are adrenal chromaffin cells . studies show that plasma free and urinary metanephrines measured by enzyme immunoassays are convenient and reliable parameters for the diagnosis of pheochromocytoma (Brain et al. Därr R, Kuhn M, Bode C, Bornstein SR, Pacak K, Lenders JWM, Eisenhofer G. Endocrine. CAS PubMed Google Scholar 84. Thus, measurements of plasma metanephrines provide a particularly good initial diagnostic test for exclusion of pheochromocytoma. Careers. diameters and the plasma concentrations of metanephrines. 2. Normal plasma concentrations of metanephrines exclude the diagnosis of pheochromocytoma, whereas normal plasma concentrations of catecholamines and normal urinary excretion of metanephrines do not. 1996, 124 (7): 694-695. 1998, 95 (21): 2482-2485. Iñiguez-Ariza NM, Kohlenberg JD, Delivanis DA, et al. Preoperatively, she was started on phenoxybenzamine 10 mg BID and encouraged on liberal salt intake. Diagnosis of pheochromocytoma in renal fail-ure poses a diagnostic dilemma due to lack of reliability of conventional urinary measurements of catecholamine excess. [Article in Swedish] Friberg P(1). There are many factors that can affect results of biochemical testing of pheochromocytoma. Over 10 studies have confirmed that the sensitivity and specificity of this test is 97% and 93% respectively; however, there is still concern for false positive results in … Scand J Clin Lab Invest. 8600 Rockville Pike 52 patients with a pheochromocytoma; 67 normotensive persons and 51 patients with essential hypertension who provided reference values; and 23 patients with secondary hypertension and 50 patients with either heart failure or angina pectoris who served as comparison groups. 2013, Unger et al. Comparison of plasma metanephrines measured by a commercial immunoassay and urinary catecholamines in the diagnosis of pheochromocytoma. This study establishes that pheochromocytomas contain considerable amounts of the membrane-bound form of COMT, resulting in local metabolism of catecholamines to free metanephrines. Plasma or urinary free metanephrines analyses seem to be the best diagnostic test, with an even higher sensitivity and specificity than analyses of deconjugated urinary metanephrines 42. OBJECTIVE: To examine whether tests for plasma metanephrines, the o-methylated metabolites of catecholamines, offer advantages for diagnosis of a pheochromocytoma over standard tests for plasma catecholamines or urinary metanephrines. A negative test result for plasma metanephrines means that a pheochromocytoma is highly unlikely so that no other tests are necessary (3) (4). Fractionated means that metanephrine and normetanephrine are measured separately. 2020 Apr 1;105(4):1145-56. doi: 10.1210/clinem/dgaa047. Normetanephrine increase to almost three times the upper normal limit alerted about a possible pheochromocytoma. National Library of Medicine study supports the conclusions of an earlier study by Lenders by showing that measurements of plasma free metanephrines offered 100% sensitivity for diagnosis of pheochromocytoma compared with only 82% sensitivity for plasma or urinary catecholamines. … A combination of alpha-blockers and beta-blockers are given pending tumor removal. The A total of 101 Japanese subjects clinically suspected of having pheochromocytoma in were included in this study. This study clearly shows measuring the PFMs levels to be a reliable and efficient method for diagnosing pheochromocytoma in Japanese patients, as demonstrated in previous reports. PDF | Introduction: The critical step in diagnosing pheochromocytoma. AACE Clin Case Rep. 2020 Aug 6;6(6):e286-e289. [Biological diagnosis of pheochromocytoma: impact of technological improvement]. METHODS Over a 2-year period, consecutive patients attending the endocrine clinic at King Edward Memorial Hospital, Mumbai, India, for suspicion of catecholamine-secreting tumors were included. 2009 Jul;161(1):131-40. doi: 10.1530/EJE-09-0172. FOIA Scand J Clin Lab Invest. Because no statistical difference was noted in the number of false-positive results between tests for plasma metanephrines (15%) and tests for plasma catecholamines (18%), the specificities of the two tests did not differ. basal plasma catecholamines due to variable and inter-mittent release is unsuitable for screening due to their periodic release [21–25]. Accuracy of recommended sampling and assay methods for the determination of plasma-free and urinary fractionated metanephrines in the diagnosis of pheochromocytoma and paraganglioma: a systematic review. Epub 2017 Apr 12. Bloomer ZW, Bauer EM, Hoang TD, Shakir MKM. Clipboard, Search History, and several other advanced features are temporarily unavailable. It also confirms that functional imaging by 6-[ 18 F]fluorodopamine or 123 I-metaiodobenzylguanidine scanning can localize pheochromocytoma in difficult cases in which other imaging tests are not diagnostic. Measurement of free plasma metanephrines (metanephrine and normetanephrine), usually performed by high-performance liquid chromatography with electrochemical detection (HPLC-ECD), has been recommended as the single biochemical test of choice for the diagnosis of pheochromocytoma. Plasma and urinary metanephrines determined by an enzyme immunoassay, but not serum chromogranin A for the diagnosis of pheochromocytoma in patients with adrenal mass. 2004; 4:2. Results: Extraction of plasma free metanephrines The extraction of plasma free metanephrines was done using Lender's method with some modifications. Would you like email updates of new search results? 2018 Nov;30(6):887-893. doi: 10.1177/1040638718793168. The negative predictive value of normal plasma concentrations of catecholamines was 95% (156 of 164 patients). Ann Intern Med 1995; 123:101. Tests for plasma metanephrines are more sensitive than tests for plasma catecholamines or urinary metanephrines for the diagnosis of pheochromocytoma. Ann Intern Med. Diagnosis of pheochromocytoma in renal fail-ure poses a diagnostic dilemma due to lack of reliability of conventional urinary measurements of catecholamine excess. Combining different tests did not improve the diagnostic yield beyond that of a single test of plasma free metanephrines. In patients with pheochromocytoma, over 94% of the elevated plasma concentrations of normetanephrine or metanephrine are derived from metabolism of catecholamines by the catechol-O-methyltransferase within pheochromocytoma tumor cells and not by actions of extra-adrenal catechol-O-methyltransferase on catecholamines released by tumors into the circulation (41). Plasma methoxytyramine: clinical utility with metanephrines for diagnosis of pheochromocytoma and paraganglioma Dipti Rao1, Mirko Peitzsch2, Aleksander Prejbisz3, Katarzyna Hanus3, Martin Fassnacht4, Felix Beuschlein5, Christina Brugger5, Stephanie Fliedner6, Katharina Langton7, Christina Pamporaki7, Volker Gudziol8, Anthony Stell9, Conclusions: Normal plasma concentrations of metanephrines exclude the diagnosis of pheochromocytoma, whereas normal plasma concentrations of catecholamines and normal urinary excretion of metanephrines do not. FOIA Curr Hypertens Rep. 2002 Jun;4(3):250-5. doi: 10.1007/s11906-002-0015-4. SETTING: 3 clinical specialist centers. Sawka AM, Prebtani AP, Thabane L, Gafni A, Levine M, Young WF A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma. As this test has not yet been evaluated in Japan, it is necessary to evaluate the diagnostic efficacy of measuring the levels of PFMs compared with the standard measurement of the urinary excretion of metanephrines (uMNs) whose reliability is well established to detect of pheochromocytoma. Conclusion: Plasma free metanephrines provide the best test for excluding or confirming pheochromocytoma and should be the test of first choice for diagnosis of the tumor. Measuring the levels of the plasma free metanephrines (PFMs) represents a recently developed and promising test for the diagnosis of pheochromocytoma in the United States and Europe. Background: Measurement of plasma-free metanephrines is the test of choice to identify pheochromocytoma in human patients. Urinary Norepinephrine Is a Metabolic Determinant of 24-Hour Energy Expenditure and Sleeping Metabolic Rate in Adult Humans. Objective To determine the biochemical test or combination of tests that provides the best method for diagnosis of pheochromocytoma.. Design, Setting, and Participants Multicenter cohort … Tests for urinary metanephrines yielded five false-negative results and a sensitivity of 89% (41 of 46 patients [CI, 76% to 96%]). Epub 2009 Apr 21. studies show that plasma free and urinary metanephrines measured by enzyme immunoassays are convenient and reliable parameters for the diagnosis of pheochromocytoma (Brain et al. Accessibility Objective: Various studies have validated plasma free metanephrines (MNs) as biomarkers for pheochromocytoma and paraganglioma (PPGL). doi: 10.4158/ACCR-2020-0225. The results of comparisons in the accuracy of measurement for diagnosis of pheochromocytoma between PFMs and the urinary excretion of metanephrines (uMNs) were 0.980 VS 0.951 for AUC of receiver operatorating characteristic (ROC) curve, 0.957 VS 0.894 for sensitivity, and 0.973 VS 0.946 for specificity, respectively. Evaluation of an enzyme immunoassay for plasma-free metanephrines in the diagnosis of catecholamine-secreting tumors. Measurements of the plasma metanephrines, normetanephrine and metanephrine (the O-methylated metabolites of nore- National Library of Medicine Although the differences were small, the results of our study definitely demonstrated that measurement of PFMs was not inferior to standard urinary metanephrines (uMNs) measurement, which is established to be the most reliable biochemical method to detect pheochromocytoma. Searching for pheochromocytoma: a new and better test? A negative test result for plasma metanephrines means that a pheochromocytoma is highly unlikely so that no other tests are necessary . BMC Endocr Disord. Design: Prevention and treatment information (HHS). Author information: (1)Avdelningen för klinisk fysiologi, Sahlgrenska Universitetssjukhuset, Göteborg. PDF | Introduction: The critical step in diagnosing pheochromocytoma. The results of comparisons in the accuracy of measurement for diagnosis of pheochromocytoma between PFMs and the urinary excretion of metanephrines (uMNs) were 0.980 VS 0.951 for AUC of receiver operatorating characteristic (ROC) curve, 0.957 VS 0.894 for sensitivity, and 0.973 VS 0.946 for specificity, respectively. In addition, evaluation of this parameter in plasma samples would overcome the problems associated with collecting 24-hour urine samples. Ann N Y Acad Sci. All four patients with unexplained false positive results had normal 24-h urine values on repeat testing. Epub 2011 Oct 24. May 17, 2021 Results: More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to Review of the literature Clinical presentation and diagnosis of pheochromocytoma 1996 Apr;81(4):1378-84. doi: 10.1210/jcem.81.4.8636337. Plasma free metanephrines levels above 3-4 times normal almost always indicates the presence of pheochromocytoma and the diagnosis is made. Plasma metanephrine testing has the highest sensitivity (96%) for detecting a pheochromocytoma, but it has a lower specificity (85%). 3 clinical specialist centers. No patient with a pheochromocytoma had normal plasma concentrations of both normetanephrine and metanephrine. Objective: Patients with pheochromocytoma (n = 17) and with histologically proved other adrenal tumors (n = 14) were studied before, during, and after surgery. Both tests are approximately 95% accurate. Tumors should be localized with imaging tests, sometimes using radiolabeled compounds. All subjects with adrenal tumors underwent tumor excision. In patients with pheochromocytoma the free metanephrines are produced within tumor cells from catecholamines leaking from storage vesicles continuously and … Eur J Endocrinol. Annals of Internal Medicine. Choice of biochemical test for diagnosis of pheochromocytoma: validation of plasma metanephrines. Clipboard, Search History, and several other advanced features are temporarily unavailable. This site needs JavaScript to work properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. DESIGN: Cross-sectional study. The 24-hour urinary excretion of metanephrines was measured in 46 patients with pheochromocytoma. Elijovich F. PMID: 8607605 [PubMed - indexed for MEDLINE] 2000;160:2957-2963 diagnosis of pheochromocytoma in adult population. In a group of 63patients with histologically-proven pheochromocytoma (52PHEO and Plasma fNMN concentration has excellent sensitivity and specificity for the diagnosis of pheochromocytoma in dogs, whereas fMN concentration has moderate sensitivity and excellent specificity. Ann Intern Med. Plasma metanephrines in the diagnosis of pheochromocytoma. The finding of normal plasma levels and urinary excretion rates of catecholamines, with elevated plasma free normetanephrine levels, can be explained by episodic release of catecholamines, whereas metanephrines are produced continuously from leakage of catecholamines from storage vesicles into the cytoplasm of pheochromocytoma tumor cells. Elijovich F: Plasma metanephrines in the diagnosis of pheochromocytoma. Plasma fMN and fNMN concentrations generally are considered to be the optimal test for diagnosing pheochromocytoma in humans and are reported to be more accurate than other biochemical tests, including urinary metanephrine‐to‐creatinine ratios. Measurements: Lakartidningen. The 24-hour urine test and the blood plasma test are equally effective at measuring of free metanephrines and ultimately providing a diagnosis. This meta-analysis aimed to estimate the overall diagnostic accuracy of this biochemical test for PPGL. Setting: Hence, we studied the performance of plasma fractionated free metanephrines by enzyme immunoassay (EIA) in the diagnosis of pheochromocytoma and paraganglioma. False-positives can occur due to a variety of reasons. Measuring the levels of the plasma free metanephrines (PFMs) represents a recently developed and promising test for the diagnosis of pheochromocytoma in the United States and Europe. Combining different tests did not improve the diagnostic yield beyond that of a single test of plasma free metanephrines. Plasma metanephrines offer improved efficacy for the diagnosis of pheochromocytoma. This work discusses the clinical performance of chromogranin A, free metanephrine and normetanephrine determination in plasma using a radioimmunoanalytical methods for the diagnosis of pheochromocytoma and paraganglioma.
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