This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (60)  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Wolfgang Raber, MD; Wolfgang Raffesberg; Martin Bischof, MD; Christian Scheuba, MD; Bruno Niederle, MD; Slobodan Gasic, MD; Werner Waldhäusl, MD; Michael Roden, MD

Arch Intern Med. 2000;160:2957-2963.

Background  Recently, measurement of plasma metanephrines was suggested to improve the detection of pheochromocytoma compared with the other common biochemical tests.

Objective  To examine the diagnostic precision of measurements of plasma metanephrines, plasma catecholamines, and urinary catecholamines and to assess their variability.

Methods  Plasma metanephrine as well as plasma and urinary catecholamine concentrations were measured by high-performance liquid chromatography with electrochemical detection. Before surgery, responses of plasma metanephrines and catecholamines to change of posture were determined. Intraoperatively, metanephrines and catecholamines were measured before skin incision, during maximal mechanical tumor manipulation, and repetitively after the tumor was separated from the circulation. Patients were reexamined 1 and 3 months after surgery. Patients with pheochromocytoma (n = 17) and with histologically proved other adrenal tumors (n = 14) were studied before, during, and after surgery.

Results  Measurement of plasma metanephrines and plasma and urinary catecholamines provided 100% and 82% sensitivity, respectively, for the detection of pheochromocytoma (P<.001). Levels of plasma catecholamines but not metanephrines increased in response to change of posture (norepinephrine, P = .03; epinephrine, P = .07) and intraoperative stress (norepinephrine, P = .002; epinephrine, P = .009).

Conclusions  Plasma metanephrines offer improved efficacy for the diagnosis of pheochromocytoma. Less variability in response to external factors may favor plasma metanephrines in the screening for this disease.

From the Division of Endocrinology and Metabolism, Department of Medicine III (Drs Raber, Bischof, Gasic, Waldhäusl, and Roden and Mr Raffesberg), and the Department of Surgery (Drs Scheuba and Niederle), University of Vienna, Vienna, Austria.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Isopropanol Protein Precipitation for the Analysis of Plasma Free Metanephrines by Liquid Chromatography-Tandem Mass Spectrometry
Marney et al.
Clin. Chem. 2008;54:1729-1732.
ABSTRACT | FULL TEXT  

Biochemical detection of phaeochromocytoma: why are we continuing to ignore the evidence?
Peaston and Ball
Ann Clin Biochem 2008;45:6-10.
ABSTRACT | FULL TEXT  

Plasma Chromogranin A or Urine Fractionated Metanephrines Follow-Up Testing Improves the Diagnostic Accuracy of Plasma Fractionated Metanephrines for Pheochromocytoma
Algeciras-Schimnich et al.
J. Clin. Endocrinol. Metab. 2008;93:91-95.
ABSTRACT | FULL TEXT  

Pheochromocytoma: an update on genetics and management
Karagiannis et al.
Endocr Relat Cancer 2007;14:935-956.
ABSTRACT | FULL TEXT  

Comparison of Diagnostic Accuracy of Urinary Free Metanephrines, Vanillyl Mandelic Acid, and Catecholamines and Plasma Catecholamines for Diagnosis of Pheochromocytoma
Boyle et al.
J. Clin. Endocrinol. Metab. 2007;92:4602-4608.
ABSTRACT | FULL TEXT  

Plasma Free Metanephrine Measurement Using Automated Online Solid-Phase Extraction HPLC Tandem Mass Spectrometry
de Jong et al.
Clin. Chem. 2007;53:1684-1693.
ABSTRACT | FULL TEXT  

An analysis of the biochemical diagnosis of 66 pheochromocytomas
d'Herbomez et al.
Eur J Endocrinol 2007;156:569-575.
ABSTRACT | FULL TEXT  

Stability of Urinary Fractionated Metanephrines and Catecholamines during Collection, Shipment, and Storage of Samples
Willemsen et al.
Clin. Chem. 2007;53:268-272.
ABSTRACT | FULL TEXT  

Is Supine Rest Necessary before Blood Sampling for Plasma Metanephrines?
Lenders et al.
Clin. Chem. 2007;53:352-354.
ABSTRACT | FULL TEXT  

Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass.
Unger et al.
Eur J Endocrinol 2006;154:409-417.
ABSTRACT | FULL TEXT  

Nonparametric Determination of Reference Intervals for Plasma Metanephrine and Normetanephrine
Heider et al.
Clin. Chem. 2004;50:2381-2384.
FULL TEXT  

The Economic Implications of Three Biochemical Screening Algorithms for Pheochromocytoma
Sawka et al.
J. Clin. Endocrinol. Metab. 2004;89:2859-2866.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea Presenting as Pseudopheochromocytoma: A Case Report
Hoy et al.
J. Clin. Endocrinol. Metab. 2004;89:2033-2038.
ABSTRACT | FULL TEXT  

Measurement of Plasma Free Metanephrine and Normetanephrine by Liquid Chromatography-Tandem Mass Spectrometry for Diagnosis of Pheochromocytoma
Lagerstedt et al.
Clin. Chem. 2004;50:603-611.
ABSTRACT | FULL TEXT  

The Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience
Kudva et al.
J. Clin. Endocrinol. Metab. 2003;88:4533-4539.
FULL TEXT  

Pheochromocytoma: State-of-the-Art and Future Prospects
Bravo and Tagle
Endocr. Rev. 2003;24:539-553.
ABSTRACT | FULL TEXT  

Biochemical Diagnosis of Pheochromocytoma: How to Distinguish True- from False-Positive Test Results
Eisenhofer et al.
J. Clin. Endocrinol. Metab. 2003;88:2656-2666.
ABSTRACT | FULL TEXT  

Biochemical Diagnosis of Pheochromocytoma--Is it Time to Switch to Plasma-Free Metanephrines?
Eisenhofer
J. Clin. Endocrinol. Metab. 2003;88:550-552.
FULL TEXT  

A Comparison of Biochemical Tests for Pheochromocytoma: Measurement of Fractionated Plasma Metanephrines Compared with the Combination of 24-Hour Urinary Metanephrines and Catecholamines
Sawka et al.
J. Clin. Endocrinol. Metab. 2003;88:553-558.
ABSTRACT | FULL TEXT  

Reduction of Hepatic Glycogen Synthesis and Breakdown in Patients with Agenesis of the Dorsal Pancreas
Stingl et al.
J. Clin. Endocrinol. Metab. 2002;87:4678-4685.
ABSTRACT | FULL TEXT  

Imaging vs Biochemical Testing for Pheochromocytoma
Neumann et al.
JAMA 2002;288:314-315.
FULL TEXT  

Biochemical Diagnosis of Pheochromocytoma: Which Test Is Best?
Lenders et al.
JAMA 2002;287:1427-1434.
ABSTRACT | FULL TEXT  

Validation of Liquid Chromatography-Tandem Mass Spectrometry Method for Analysis of Urinary Conjugated Metanephrine and Normetanephrine for Screening of Pheochromocytoma
Taylor and Singh
Clin. Chem. 2002;48:533-539.
ABSTRACT | FULL TEXT  

Hepatic Glycogen Metabolism in Type 1 Diabetes After Long-Term Near Normoglycemia
Bischof et al.
Diabetes 2002;51:49-54.
ABSTRACT | FULL TEXT  

A ""Pheo"" Lurks: Novel Approaches for Locating Occult Pheochromocytoma
Pacak et al.
J. Clin. Endocrinol. Metab. 2001;86:3641-3646.
ABSTRACT | FULL TEXT  

Free or Total Metanephrines for Diagnosis of Pheochromocytoma: What Is the Difference?
Eisenhofer
Clin. Chem. 2001;47:988-989.
FULL TEXT  

Disappearance Rate of Catecholamines, Total Metanephrines, and Neuropeptide Y from the Plasma of Patients after Resection of Pheochromocytoma
Grouzmann et al.
Clin. Chem. 2001;47:1075-1082.
ABSTRACT | FULL TEXT