Biochemical diagnosis of chromaffin cell tumors in patients at high and low risk of disease: plasma versus urinary free or deconjugated O-methylated catecholamine metabolites
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Abstract BACKGROUND Measurements of plasma or urinary metanephrines are recommended for diagnosis of pheochromocytoma and paraganglioma (PPGL). What test offers optimal diagnostic accuracy for patients at high and low risk of disease, whether urinary free metanephrines offer advantages over deconjugated metanephrines, and what advantages are offered by including methoxytyramine in panels all remain unclear. METHODS A population of 2056 patients with suspected PPGLs underwent prospective screening for disease using mass spectrometric-based measurements of plasma free, urinary deconjugated, and urinary free metanephrines and methoxytyramine. PPGLs were confirmed in 236 patients and were excluded in others on follow-up evaluation. RESULTS Measurements of plasma free metabolites offered higher (P < 0.01) diagnostic sensitivity (97.9%) than urinary free (93.4%) and deconjugated (92.9%) metabolites at identical specificities for plasma and urinary free metabolites (94.2%) but at a lower (P < 0.005) specificity for deconjugated metabolites (92.1%). The addition of methoxytyramine offered little value for urinary panels but provided higher (P < 0.005) diagnostic performance for plasma measurements than either urinary panel according to areas under ROC curves (0.991 vs 0.972 and 0.964). Diagnostic performance of urinary and plasma tests was similar for patients at low risk of disease, whereas plasma measurements were superior to both urinary panels for high-risk patients. CONCLUSIONS Diagnosis of PPGLs using plasma or urinary free metabolites provides advantages of fewer false-positive results compared with commonly measured deconjugated metabolites. The plasma panel offers better diagnostic performance than either urinary panel for patients at high risk of disease and, with appropriate preanalytics, provides the test of choice. Measurements of methoxytyramine in urine show limited diagnostic utility compared with plasma.
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Specificity rates of 85% to 89% for metanephrine testing decrease to 77% in elderly people and can be improved by using age-adjusted reference ranges.
“Specificity rates of 85% to 89% decrease to 77% in elderly people and can be improved by using age-adjusted reference ranges (204-206).”
From Adrenal incidentaloma (2020) · cites this paper as [205]
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- Authors
- Eisenhofer, G., Prejbisz, A., Peitzsch, M., Pamporaki, C., Masjkur, J., Rogowski-Lehmann, N., Langton, K., Tsourdi, E., Pęczkowska, M., Fliedner, S., Deutschbein, T., Megerle, F., Timmers, H. J. L. M., Sinnott, R., Beuschlein, F., Fassnacht, M., Januszewicz, A., & Lenders, J. W. M.
- Affiliations
- Technische Universität Dresden (DE)
- Institute of Cardiology (PL)
- LMU Klinikum (DE)
- University Hospital Schleswig-Holstein (DE)
- University of Würzburg (DE)
- Radboud University Medical Center (NL)
- The University of Melbourne (AU)
- Corresponding author
- Eisenhofer, Graeme
- ORCID
- Eisenhofer, Graeme
- Prejbisz, Aleksander
- Peitzsch, Mirko
- Pamporaki, Christina
- Masjkur, Jimmy
- Rogowski-Lehmann, Natalie
- Langton, Katharina
- Tsourdi, Elena
- Pęczkowska, Mariola
- Fliedner, Stephanie
- Deutschbein, Timo
- Megerle, Felix
- Timmers, Henri J L M
- Sinnott, Richard
- Beuschlein, Felix
- Fassnacht, Martin
- Januszewicz, Andrzej
- Lenders, Jacques W M
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-11-01
- Volume
- 64
- Issue
- 11
- Pages
- 1646-1656
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- OpenAlex
- W2886601036
- Cited by
- 181
- References
- 35
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 25 · 2023: 31 · 2022: 25 · 2021: 29 · 2020: 21 · 2019: 16 · 2018: 3
- FWCI
- 17.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Chemistry (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- European Commission (2007–2013, FP7 2007-2013, HORIZON2020, 259735, FP7/2007, 633983)
- Deutsche Forschungsgemeinschaft (CRC/Transregio 205, KFO 252, FP7/2007–2013, CRC/Transregio 205/1, 205/1)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- pheochromocytoma, paraganglioma, chromaffin cell tumors, metanephrine, methoxytyramine, sensitivity and specificity, false positives, catecholamine metabolites
- MeSH terms
- Adolescent, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Dopamine, Female, Follow-Up Studies, Humans, Male, Metanephrine, Middle Aged, Paraganglioma, Predictive Value of Tests, Prospective Studies, ROC Curve, Sensitivity and Specificity, Chromaffin Cells, Young Adult
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