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Endocrine Abstracts (2019) 63 S 9.1 | DOI: 10.1530/endoabs.63.S9.1

Germany.


Measurements of plasma or urinary metanephrines are recommended for diagnosis of pheochromocytoma and paraganglioma (PPGL). Differences of opinion exist concerning what test offers optimal diagnostic accuracy and whether supine sampling is required for the plasma test. Whether urinary free metanephrines offer advantages over deconjugated metabolites and the relative utilities of additional measurements of methoxytyramine are also unclear. This presentation covers 25 years of experience with PPGL, including a recent prospective study of 2,056 patients with suspected PPGL, among who 236 had tumors confirmed. Patients at high risk for PPGL were screened due to an incidentaloma, hereditary risk or past history of PPGL, whereas those at low risk were tested because of signs and symptoms of apparent catecholamine excess. With seated sampling the plasma test suffers from compromised specificity rendering diagnostic performance no better than urinary tests. With supine sampling the plasma test offers higher diagnostic sensitivity than urinary free and deconjugated metabolites at identical specificities for plasma and urinary free metabolites, but lower specificities for deconjugated metabolites. Addition of methoxytyramine is useful for the plasma panel, but offers negligible value for urinary panels. Superiority of plasma over urinary tests is most apparent for patients at high risk of PPGL, whereas diagnostic performance differs little for those at low risk. The superior diagnostic performance of the plasma than both urinary panels for patients at high risk of PPGL indicates preference for this test at specialist centers where such patients may be best managed, but only with appropriate pre-analytics. At other centers where it is not possible to sample blood in the supine position or where testing is largely carried out because of signs and symptoms it may be preferable to use urinary measurements. In this case traditional measurements of deconjugated metanephrines should be abandoned in favor of the free metabolites.

Volume 63

21st European Congress of Endocrinology

Lyon, France
18 May 2019 - 21 May 2019

European Society of Endocrinology 

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