A critical review of diagnostic tests for pheochromocytoma

Biochemical tests for pheochromocytoma: strategies in hypertensive patients

OBJECTIVE

To determine the optimal clinical strategy utilizing either 1) serum catecholamines, 2) urinary metanephrines, or 3) urinary vanillylmandelic acid measurements in the evaluation of hypertensive patients with suspected pheochromocytoma.

DESIGN

Prospective clinical determination of test-operating characteristics.

SETTING

Tertiary care university medical center.

PATIENTS/PARTICIPANTS

415 patients referred for evaluation of suspected pheochromocytoma.

INTERVENTIONS

All subjects had measurements of the three above-mentioned biochemical tests with the diagnosis of pheochromocytoma established by tissue confirmation.

RESULTS

All three biochemical tests were similar in sensitivity (0.70-0.75), specificity (0.90-0.95), and receiver operating characteristics. With an estimated disease prevalence of 5.9% in symptomatic hypertensive patients, the predictive value of any single negative test would be 98% in ruling out disease.

CONCLUSIONS

All three biochemical tests have similar performance characteristics and only a single test need be performed to exclude pheochromocytoma in most symptomatic hypertensive patients in a primary care population.

High performance liquid chromatographic analysis of urinary catecholamines employing amperometric detection: references values and use in laboratory diagnosis of neural crest tumors

We have developed an high performance liquid chromatographic procedure employing amperometric detection for the measurement of urinary free norepinephrine, epinephrine and dopamine. The between-day precision (C.V.) at various concentrations of the above analytes varied from 4.8-11.6%. There was negligible between-urine difference in the percent recovery of norepinephrine and epinephrine but considerable between-urine difference for dopamine. The procedure has been used to determine reference ranges in infants, children and adults. Its preliminary application to the laboratory detection of neural crest tumors is also described.

Hypertension: strategies for laboratory diagnosis

Although surgically correctable causes account for relatively few cases of hypertension, laboratory investigation is warranted if clinical clues are present. Pheochromocytoma, which triggers hypertension by producing excess catecholamines, can be identified by detecting metabolites of these substances in urine. An abnormal intravenous pyelogram suggests renovascular hypertension, but for definitive diagnosis, bilateral renal vein renin measurements are necessary. In primary aldosteronism, with its characteristic hypokalemia, serum potassium determination remains the most feasible, if not the most accurate, detection method.

Vesical-related paragangliomas

A review is presented of vesical-related paragangliomas and 3 cases are reported. Methods for early diagnosis, including selective angiographic demonstration, and treatment of these rare tumors are discussed. A multi-team approach by the urologist, endocrinologist and anesthesiologist is stressed for better control of potentially dangerous vasomotor changes during diagnosis and surgical treatment of this tumor.

Current management of pheochromocytoma

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