Cited by 181Adrenal and Paraganglionic TumorsMetabolism and Genetic DisordersNeuroendocrine Tumor Research Advances

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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Eisenhofer, Graeme, Prejbisz, Aleksander, Peitzsch, Mirko, Pamporaki, Christina, Masjkur, Jimmy, Rogowski-Lehmann, Natalie, Langton, Katharina, Tsourdi, Elena +10 more·2018·Clinical Chemistry

Abstract

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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Research works printed but not linked: 3

  1. Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phae- ochromocytoma. Lancet 2005;366:665-75.
  2. Lenders JWM, Duh QY, Eisenhofer G, Gimenez- Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromo- cytoma and paraganglioma: an endocrine society clini- cal practice guideline. J Clin Endocrinol Metab 2014; 99:1915-42.
  3. Boyle JG, Davidson DF, Perry CG, Connell JM. Compar- ison of diagnostic accuracy of urinary free metaneph- rines VMA, and catecholamines and plasma cat- echolamines for diagnosis of pheochromocytoma. J Clin Endocrinol Metab 2007;92:4602-8.

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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
Venue
Clinical Chemistry
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
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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