Aim To determine the most common indications for measuring metanephrine and normetanephrine in plasma by gender and age and to compare the concentrations of metanephrine and normetanephrine by indication, gender and age. Methods The study was conducted on 224 patients whose plasma metanephrine and normetanephrine concentrations were measured at the Clinical Institute for Laboratory Diagnostics at the University Hospital Centre Osijek for one year, until 1st January 2020. Results The most frequent indications for biochemical testing were adrenal incidentaloma, 138 (6.6 %), and symptoms of pheochromocytoma, 41 (18.3%). Metanephrine concentration was lower in females (p=0.009). No significant correlation was found between age and metanephrine concentration, while age and normetanephrine concentration were positively correlated (p=0.01). Of the 224 patients, only one patient was diagnosed with pheochromocytoma, whose indication for measurement of metanephrine and normetanephrine was adrenal incidentaloma. Conclusion Adrenal incidentalomas and symptoms suggestive of pheochromocytoma are very common in the general population, while the incidence of pheochromocytoma is extremely low. Clear guidelines for the referral of patients for biochemical testing are needed to avoid unnecessary costs and to identify the correct diagnosis promptly
Adler J, Meyer-Rochow G, Chen H, Robinson B, Sippel B, Sidhu R, et al. Pheochromocytoma: current approaches and future directions. The Oncologist. 2008. p. 779–93.
2.
Davison A, Jones D, Ruthven S, Helliwell T. Shore SL. Clinical evaluation and treatment of phaeochromocytoma. Ann Clin Biochem. 2018. p. 34–48.
3.
Van Berkel A, Lenders J, Timmers H. Diagnosis of endocrine disease: biochemical diagnosis of phaeochromocytoma and paraganglioma. Eur J Endocrinol. 2014. p. R109-119.
4.
Tevosian S, Ghayee H. Pheochromocytomas and Paragangliomas. Endocrinol Metab Clin North Am. 2019. p. 727–50.
5.
Reisch N, Peczkowska M, Januszewicz A, Neumann H. Pheochromocytoma: presentation, diagnosis and treatment. J Hypertens. 2006. p. 2331–9.
6.
Sbardella E, Grossman A. Pheochromocytoma: an approach to diagnosis. Best Pract Res Clin Endocrinol Metab. 2020. p. 101346.
7.
Manger W, Pheochromocytoma G. J Clin Hypertens. 2002. p. 62–72.
8.
Soltani A, Pourian M, Davani B. Does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. Diabetes Metab Disord. 2016. p. 6.
9.
Lawrence D, Salimian K, Leucker T, Martin S. Uncommon presentation, rare complication and previously undescribed oncologic association of pheochromocytoma; the great masquerader. BMJ Case Rep. 2018.
10.
Fishbein L. Pheochromocytoma/Paraganglioma: is this a genetic disorder? Curr Cardiol Rep. 2019. p. 104.
11.
Lenders J, Eisenhofer G. Update on modern management of pheochromocytoma and paraganglioma. Endocrinol Metab (Seoul). 2017. p. 152–61.
12.
Eisenhofer G. Screening for pheochromocytomas and paragangliomas. Curr Hypertens Rep. 2012. p. 130–7.
13.
Sawka A, Jaeschke R, Singh R, Wf Y. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab. 2003. p. 553–8.
14.
Farrugia F, Martikos G, Tzanetis P, Charalampopoulos A, Misiakos E, Zavras N, et al. Pheochromocytoma, diagnosis and treatment: Review of the literature. Endocr Regul. 2017. p. 168–81.
15.
Aygun N, Uludag M. Pheochromocytoma and Paraganglioma: From Clinical Findings to Diagnosis. Sisli Etfal Hastan Tip Bul. 2020. p. 271–80.
16.
Farrugia F, Pheochromocytoma C. Endocr Regul. 2019. p. 191–212.
17.
Almeida M, Bezerra-Neto J, Mendonça B, Latronico A, Fragoso M. Primary malignant tumors of the adrenal glands. Clinics. 2018. p. 756.
18.
Kraljević I. Sveučilište u Zagrebu, Medicinski fakultet. 2015.
19.
Jain A, Baracco R, Kapur G. Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management. Pediatr Nephrol. 2020. p. 581–94.
20.
Kantorovich V, Pacak K. F1000 Faculty Rev-1500. F1000Res. 2018.
21.
Lader M. Assessment methods and the differential diagnosis of anxiety. J Clin Psychopharmacol. 1981. p. 342–9.
22.
Sullivan P, Procci W, Dequattro V, Schoentgen S, Levine D, Van Der Meulen J, et al. Anger, anxiety, guilt and increased basal and stress-induced neurogenic tone: causes or effects in primary hypertension? Clin Sci (Lond). 1981. p. 389–92.
23.
Rončević T, Željković-Vrkić T, Kos J, Fištrek M. Feokromocitom -dijagnostički i terapijski izazov koji traje. (Pheochromocytoma -Ongoing Diagnostic and Therapeutic Challenges). Medicus. 2007. p. 205–10.
24.
Mercado-Asis L, Wolf K, Jochmanova I, Taïeb D. Pheochromocytoma: a genetic and diagnostic update. Endocr Pract. 2018. p. 78–90.
25.
Aufforth R, Ramakant P, Sadowski S, Mehta A, Trebska-Mcgowan K, Nilubol N, et al. Pheochromocytoma screening initiation and frequency in von Hippel-Lindau syndrome. J Clin Endocrinol Metab. 2015. p. 4498–504.
26.
Marušić R, Olujić M, Bačun T. Pheochromocytoma in pregnancy -a rare but dangerous diagnosis. Med Glas (Zenica). 2022. p. 100–5.
27.
Bholah R, Bunchman T. Review of Pediatric Pheochromocytoma and Paraganglioma. Front Pediatr. 2017. p. 155.
28.
Charles L, Triscott J, Dobbs B. Secondary hypertension: discovering the underlying cause. Am Fam Physician. 2017. p. 453–61.
29.
Lenders J, Langton K, Langenhuijsen J, Eisenhofer G. Pheochromocytoma and Pregnancy. Endocrinol Metab Clin North Am. 2019. p. 605–17.
30.
Gruber L, Hartman R, Thompson G, Mckenzie T, Lyden M, Dy B, et al. Pheochromocytoma characteristics and behavior differ depending on method of discovery. J Clin Endocrinol Metab. 2019. p. 1386–93.
31.
Alface M, Moniz P, Jesus S, Fonseca C. Pheochromocytoma: clinical review based on a rare case in adolescence. BMJ Case Rep. 2015.
32.
Eisenhofer G, Walther M, Huynh T, Li S, Bornstein S, Vortmeyer A, et al. Pheochromocytomas in von Hippel Lindau syndrome and multiple endocrine neoplasia type 2 display distinct biochemical and clinical phenotypes. J Clin Endocrinol Metab. 2001. p. 1999–2008.
33.
Pacak K, Linehan M, Eisenhofer G, Walther M, Goldstein D. Recent Advances in Genetics, Diagnosis, Localization, and Treatment of Pheochromocytoma. Ann Intern Med. 2001. p. 315–29.
34.
Sturgeon C, Angelos P. Current approach to pheochromocytoma. Oncology. 2006. p. 1450–1.
35.
Eisenhofer G, Lattke P, Herberg M, Siegert G, Qin N, Därr R, et al. Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma. Ann Clin Biochem. 2013. p. 62–9.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
