Urinary Free Metanephrines for Diagnosis of Pheochromocytoma and Paraganglioma

Background Pheochromocytoma and paraganglioma (PPGL) is diagnosed through biochemical confirmation of excessive catecholamines in urine and plasma. Recent technological developments have allowed us to measure urinary free metanephrines; however, the diagnostic accuracy of these new methods and the diagnostic cutoff values have not been evaluated. Methods This is a retrospective study of 595 subjects, including 71 PPGL cases and 524 controls. PPGL was based on pathological confirmation. Subjects with no evidence of PPGL over 2 years were included in the control group. Results Urinary free metanephrines yielded similar area under the curve (AUC) to urinary fractionated metanephrines and plasma free metanephrines. However, urinary free normetanephrine yielded a better AUC than did urinary fractionated normetanephrine. The optimal cutoff for urinary free metanephrine and normetanephrine corrected for urinary creatinine yielded 97.2% sensitivity and 98.1% specificity. Conclusion Urinary free metanephrines are a reliable method for diagnosing PPGL in Asian populations compared with existing biochemical methods.

[1]  F. Beuschlein,et al.  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. , 2018, Clinical chemistry.

[2]  Qifu Li,et al.  High specificity of spot urinary free metanephrines in diagnosis and prognosis of pheochromocytomas and paragangliomas by HPLC with electrochemical detection. , 2018, Clinica chimica acta; international journal of clinical chemistry.

[3]  J. Corcuff,et al.  Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations , 2017, Endocrine connections.

[4]  Soo-Youn Lee,et al.  A simple and rapid analytical method based on solid-phase extraction and liquid chromatography-tandem mass spectrometry for the simultaneous determination of free catecholamines and metanephrines in urine and its application to routine clinical analysis. , 2016, Clinical biochemistry.

[5]  Soo-Youn Lee,et al.  Development and Validation of Liquid Chromatography-Tandem Mass Spectrometry Method for Quantification of Plasma Metanephrines for Differential Diagnosis of Adrenal Incidentaloma , 2015, Annals of laboratory medicine.

[6]  G. Eisenhofer,et al.  Laboratory evaluation of pheochromocytoma and paraganglioma. , 2014, Clinical chemistry.

[7]  W. Young,et al.  Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. , 2014, The Journal of clinical endocrinology and metabolism.

[8]  F. Beuschlein,et al.  Simultaneous liquid chromatography tandem mass spectrometric determination of urinary free metanephrines and catecholamines, with comparisons of free and deconjugated metabolites. , 2013, Clinica chimica acta; international journal of clinical chemistry.

[9]  E. D. de Vries,et al.  Dietary influences on plasma and urinary metanephrines: implications for diagnosis of catecholamine-producing tumors. , 2009, The Journal of clinical endocrinology and metabolism.

[10]  A. Tischler,et al.  Pheochromocytoma: recommendations for clinical practice from the First International Symposium , 2007, Nature Clinical Practice Endocrinology &Metabolism.

[11]  Tigis Deboch,et al.  Indexing of Urinary Catecholamines and Metanephrines by Urinary Creatinine Levels in the Diagnosis of Phaeochromocytoma , 2006 .

[12]  W. Young,et al.  A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. , 2003, The Journal of clinical endocrinology and metabolism.

[13]  K. Pacak,et al.  Understanding Catecholamine Metabolism as a Guide to the Biochemical Diagnosis of Pheochromocytoma , 2001, Reviews in Endocrine and Metabolic Disorders.

[14]  G. Eisenhofer.  Free or total metanephrines for diagnosis of pheochromocytoma: what is the difference? , 2001, Clinical chemistry.

[15]  M. Roden,et al.  Diagnostic efficacy of unconjugated plasma metanephrines for the detection of pheochromocytoma. , 2000, Archives of internal medicine.

[16]  G. Chatellier,et al.  The Urinary Metanephrine-to-Creatinine Ratio for the Diagnosis of Pheochromocytoma , 1996, Annals of Internal Medicine.

[17]  Moon-Kyu Lee,et al.  Diagnostic accuracy of plasma free metanephrines in a seated position compared with 24-hour urinary metanephrines in the investigation of pheochromocytoma. , 2015, Endocrine journal.

[18]  W. Young.  Clinical practice. The incidentally discovered adrenal mass. , 2007, The New England journal of medicine.

[19]  J. Dussault,et al.  Catecholamine metabolism in thyroid disease. II. Norepinephrine secretion rate in hyperthyroidism and hypothyroidism. , 1977, The Journal of clinical endocrinology and metabolism.