A Comparison of Biochemical Tests for Pheochromocytoma: Measurement of Fractionated Plasma Metanephrines Compared with the Combination of 24-Hour Urinary Metanephrines and Catecholamines
Abstract
We compared the diagnostic efficacy of fractionated plasma metanephrine measurements to measurements of 24-h urinary total metanephrines and catecholamines in outpatients tested for pheochromocytoma at Mayo Clinic Rochester from January 1, 1999, until November 27, 2000. Catecholaminesecreting tumors were histologically proven. The sensitivity of fractionated plasma metanephrines was 97% (30 of 31 patients), compared with a sensitivity of 90% (28 of 31) for urinary total metanephrines and catecholamines (P = 0.63). The specificity of fractionated plasma metanephrines was 85% (221 of 261), compared with 98% (257 of 261; P < 0.001) for urinary measurements. The likelihood ratios for positive tests were 6.3 (95% confidence interval, 4.7 to 8.5) for fractionated plasma metanephrines and 58.9 (95% confidence interval, 22.1 to 156.9) for urinary total metanephrines and catecholamines. An adrenal pheochromocytoma was missed by urinary testing in two patients with familial syndromes and one asymptomatic patient with an incidentally discovered adrenal mass. An extra-adrenal paraganglioma was missed by plasma testing in one patient. In conclusion, measurements of 24-h urinary total metanephrines and catecholamines yield fewer false-positive results, an attribute preferred for testing low-risk patients, but fractionated plasma metanephrine measurements may be preferred in high-risk patients with familial endocrine syndromes.
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Measurement of plasma metanephrines or 24-hour urinary metanephrines is an effective screening test for patients in whom paraganglioma or pheochromocytoma is suspected.
“Measurement of plasma metanephrines or 24-hour urinary metanephrines is an effective screening test for patients in whom paraganglioma or pheochromocytoma is suspected.346”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [346]
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- Authors
- Sawka, A. M., Jaeschke, R., Singh, R. J., & Young, W. F.
- Affiliations
- Mayo Clinic (US)
- St. Joseph’s Healthcare Hamilton (CA)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2003-02
- Volume
- 88
- Issue
- 2
- Pages
- 553-558
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1979170245
- Cited by
- 503
- References
- 24
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 10 · 2023: 8 · 2022: 21 · 2021: 18 · 2020: 14 · 2019: 17 · 2018: 10 · 2017: 24 · 2016: 21 · 2015: 19 · 2014: 29 · 2013: 27 · 2012: 22
- FWCI
- 25.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Clinic
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Keywords
- pheochromocytoma, catecholamines, sensitivity and specificity, likelihood ratios, paraganglioma, adrenal incidentaloma, false positives
- MeSH terms
- Adolescent, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Catecholamines, Child, Female, Head and Neck Neoplasms, Humans, Male, Metanephrine, Middle Aged, Outpatients, Paraganglioma, Pheochromocytoma, Sensitivity and Specificity
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