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Old 07-05-2011
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Question pheochromocytoma what best initial test?

confused between kaplan IM and kaplan Pediatric about pheochromocytoma

what best initial test : VMA or metanephrine in urine

what most accurate test ??

when to use serum metanephrine ??

please any can help
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Old 07-05-2011
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Best initial test: Plasma metanephrine followed by urine metanephrine
most accurate test: Plasma metanephrine has more sensitivity than urine
Indication for serum metanephrine: When urine metanephrine is positive or borderline
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Old 07-05-2011
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Uptodate (briefly urinary fractioned metanephrines for low risk/ plasma fractioned metanephrines for high risk/if either is negative-->rule out, if either positive perform imaging)

Many patients are screened for possible sporadic pheochromocytoma, while few will ultimately be diagnosed with the disorder (approximately 1 in 300). There has been no consensus regarding the best diagnostic test for pheochromocytoma. Historically, 24-urinary catecholamines and their metabolites were measured, but more recently plasma fractionated metanephrines have been recommended by some experts as the best test in all situations. In contrast, we suggest that plasma fractionated metanephrines are the best test in patients who are at high risk for pheochromocytoma (those with a high pre-test probability of disease), while in other lower risk patients, we still recommend the urinary tests as follows:
Typical triad Patients with the triad of headache, sweating and tachycardia, whether or not they have hypertension, should be evaluated for pheochromocytoma. In addition, patients with spells (defined as a sudden onset of a symptom or symptoms that are recurrent, self-limited, and stereotypic in nature) that relate to paroxysmal elevations in blood pressure should be evaluated for pheochromocytoma [9]. However, the clinician should recognize that most patients with spells do not have a pheochromocytoma [9].
  • We do not consider these patients to be at high risk for pheochromocytoma, and therefore we suggest initial screening with a 24-hour urinary fractionated metanephrines (figure 1). If the results are normal, no further testing is needed, while if the results are significantly elevated, imaging with CT or MRI is required.
Paroxysmal hypertension Patients with hypertension that is poorly responsive to standard therapy should be evaluated. The pre-test probability of a pheochromocytoma in this scenario is low.
  • We suggest screening with 24-hour urinary fractionated metanephrines (figure 1). If the results are normal, no further testing is needed, while if the results are significantly elevated, imaging with CT or MRI is required.
Adrenal incidentalomas We suggest measuring 24-hour urinary fractionated metanephrines and catecholamines routinely in patients with adrenal incidentalomas (figure 1).
  • If the adrenal mass is vascular or if there are other features to suggest pheochromocytoma (eg, high Hounsfield unit density pre-contrast or delayed contrast washout), plasma fractionated metanephrines should be measured. If the biochemical tests are negative, no further testing is required. Adrenal incidentalomas should be followed with both imaging and repeat biochemical testing as outlined. (See"The adrenal incidentaloma".)
High risk Patients considered being high risk for pheochromocytoma (eg, high-risk familial syndromes such as MEN2 and von Hippel-Lindau syndrome, previously surgically cured pheochromocytomas or paragangliomas).
  • We suggest plasma fractionated metanephrines in this high risk group. A normal value excludes a symptomatic catecholamine-secreting neoplasm, but mildly elevated values of normetanephrine could be falsely positive, in which case we suggest doing 24-urinary fractionated metanephrines, catecholamines, and imaging
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The above post was thanked by:
rigbbm (08-26-2013), Taiwan_Guy (07-25-2011), yugao (02-20-2014)


Endocrinology-, Internal-Medicine-

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