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Old 11-28-2011
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Question Best Initial Test for Pheochromocytoma

What is the best initial test for pheochromocytoma? is it plasma metanephrines or urinary metabolites? any references? in Kaplan its given plasma metanephrines but i remember reading it as urinary in my under graduation
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As i know plasma levels are best initial. Whereas 24h urinary levels is the most accurate.
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ok can u cite any reference?i dint knw abt the accurate part of it till now
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Old 11-28-2011
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i think most accurate test is plasma free metaneprines. i attach ref from kapaln qbank.
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From
Williams Textbook of Endocrinology, 12th ed. 2011

At Mayo Clinic, the most reliable case-detection strategy is measurement of fractionated metanephrines and catecholamines in a 24-hour urine collection (sensitivity, 98%; specificity, 98%). If clinical suspicion is high, then plasma fractionated metanephrines, which are products of intrapheochromocytoma catecholamine metabolism, should also be measured. Some groups have advocated that plasma fractionated metanephrines should be a first-line test for pheochromocytoma; the predictive value of a negative test is extremely high, and a normal result excludes pheochromocytoma except in patients with early preclinical disease and those with strictly dopamine-secreting neoplasms. A plasma test is also attractive because of its simplicity. Although measurement of plasma fractionated metanephrines has a sensitivity of 96% to 100%, the specificity is poor at 85% to 89%, and the specificity falls to 77% in patients older than 60 years of age. It has been estimated that 97% of patients with hypertension seen in a tertiary care clinic who have plasma fractionated metanephrine measurements above the reference range will not have a pheochromocytoma and this results in excessive health care expenditures because of subsequent imaging and potentially inappropriate surgery. Therefore, plasma fractionated metanephrines lack the necessary specificity to be recommended as a first-line test, and this measurement should be reserved for cases in which the index of suspicion is high.

From
The North American Neuroendocrine Tumor Society Consensus Guideline for the Diagnosis and Management of Neuroendocrine Tumors: Pheochromocytoma, Paraganglioma, and Medullary Thyroid Cancer
Pancreas:
August 2010 - Volume 39 - Issue 6 - pp 775-783
"In line with these concepts, numerous independent studies have now confirmed that measurements of fractionated metanephrines (ie, normetanephrine and metanephrine measured separately) in urine or plasma provide superior diagnostic sensitivity over measurement of the parent catecholamines. However, to preserve high diagnostic sensitivity, it is strongly recommended to obtain blood samples in the supine position.
Current recommendations are that initial testing for pheochromocytoma or paraganglioma must include measurements of fractionated metanephrines in plasma, urine, or both, as available."
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Old 11-28-2011
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Best initial test - Plasma metanaphtine and then conformed with 24 hour urine - from kaplan
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Source is Medscape.
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Old 11-28-2011
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ok thanks all i will stick to plasma meta then
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