pheochromocytoma what best initial test? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
USMLE Articles
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam

Thread Tools Search this Thread Display Modes
Old 07-05-2011
kemoo's Avatar
USMLE Forums Guru
Steps History: 1+CK+CS
Posts: 378
Threads: 161
Thanked 101 Times in 51 Posts
Reputation: 115
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
Reply With Quote Quick reply to this message

Old 07-05-2011
Ace3's Avatar
USMLE Forums Master
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 285 Times in 191 Posts
Reputation: 297

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
Reply With Quote Quick reply to this message
Old 07-05-2011
USMLE Forums Scout
Steps History: Not yet
Posts: 79
Threads: 12
Thanked 212 Times in 37 Posts
Reputation: 224

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
Reply With Quote Quick reply to this message
The above post was thanked by:
rigbbm (08-26-2013), Taiwan_Guy (07-25-2011), yugao (02-20-2014)


Endocrinology-, Internal-Medicine-

Quick Reply

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Please enter a password for your user account. Note that passwords are case-sensitive.
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Where you live. Leave blank if you don't want to tell.


Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Similar Threads
Thread Thread Starter Forum Replies Last Post
Ischemic Colitis Best Initial Test! geof1 USMLE Step 2 CK Forum 7 08-30-2011 02:38 PM
cardiology : question best initial test Dr.kaushik USMLE Step 2 CK Forum 11 05-23-2011 08:30 PM
When is ERCP the initial test? Haisook USMLE Step 2 CK Forum 1 04-08-2011 01:04 PM
PJP Diagnosis; Best Initial Test! Salwan85 USMLE Step 2 CK Forum 2 03-25-2010 03:10 PM
Initial Test is the Final Test? Hohepa USMLE Step 2 CK Forum 4 03-23-2010 11:49 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2016 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)