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Objectives: Inconsistent elevation of catecholamines (CAs) and metanephrines (MNs) was observed in pheochromocytomas/paragangliomas (PPGLs). This study aimed to explore its potential causes and report the diagnostic efficacy of MNs and CAs in a large Chinese PPGL cohort., Methods: Clinical data and results of hormone tests were retrospectively collected. The sensitivity of plasma MNs and 24h-urinary CAs was analyzed. Clinical characteristics were compared between patients with positive and negative biochemical results, and among those with inconsistent elevation of MNs and CAs., Results: Seven hundred and three patients were included, with a median onset age of 41.0 years. Plasma MNs (93% ~ 99%) showed prior diagnostic sensitivity to 24h-urinary CAs (74% ~ 89%). Patients with negative biochemical results presented as a smaller tumor (1.7 cm vs. 4.3 cm, P = 0.001), a higher proportion of normal blood pressure (60.0% vs. 20.5%, P = 0.002) and negative 131 I-meta-iodobenzylguanidine ( 131 I-MIBG) imaging (55.6% vs. 17.3%, P = 0.012). An earlier age of onset (40.0 vs. 41.0 vs. 44.5 years, P = 0.025), a higher proportion of paroxysmal hypertension (36.5% vs. 29.2% vs. 32.2%, P = 0.005) and the Epinephrine secretion type (79.3% vs. 37.7% vs. 48.0%, P < 0.001) were found in patients with the ratio of MNs/CAs elevation multiples <0.5 than those with the ratio between 0.5 and 2 or >2., Conclusions: Plasma MNs exhibited a superior sensitivity than 24-h-urinary CAs in the Chinese PPGL diagnosis. Patients with a small tumor, normal blood pressure and negative 131 I-MIBG imaging were prone to express negative biochemical levels. Additionally, an obvious elevation of 24-h-urinary CAs than plasma MNs was correlated to paroxysmal hypertension and the Epinephrine type., Competing Interests: Compliance with ethical standards. Ethical approval: This study was approved by the institutional review board of the Peking Union Medical College Hospital in Beijing, China. Written informed consent was obtained from all patients. The authors affirm that all patients provided informed consent for publication of their data. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Pheochromocytoma is associated with systemic inflammation but the underlying mechanisms are unclear. Therefore, we investigated the relationship between plasma metanephrine levels and hematological parameters-as a surrogate of inflammation-in patients with pheochromocytoma and the influence of preoperative α-blockade treatment., Design and Methods: We retrospectively studied 68 patients with pheochromocytoma who underwent adrenalectomy (median age, 53 years; 64.7% females) and 2 control groups matched for age, sex, and body mass index: 68 patients with nonfunctioning adrenocortical tumors and 53 with essential hypertension. The complete blood count and several inflammation-based scores (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR], systemic-immune-inflammation index [SII], prognostic-nutrition index) were assessed in all patients and, in a subset of pheochromocytomas, after adrenalectomy (n = 26) and before and after preoperative α-blockade treatment (n = 29)., Results: A higher inflammatory state, as indicated by both complete blood count and inflammation-based scores, was observed in patients with pheochromocytoma compared with nonfunctioning adrenocortical tumors and essential hypertension. Plasma metanephrine levels showed a positive correlation with NLR (r = 0.4631), PLR (r = 0.3174), and SII (r = 0.3709) and a negative correlation with LMR (r = 0.4368) and prognostic-nutrition index (r = 0.3741), even after adjustment for age, sex, ethnicity, body mass index, and tumor size (except for PLR). After adrenalectomy, we observed a reduction in NLR (P = .001), PLR (P = .003), and SII (P = .004) and a concomitant increase in LMR (P = .0002). Similarly, α-blockade treatment led to a reduction in NLR (P = .007) and SII (P = .03)., Conclusion: Inflammation-based scores in patients with pheochromocytoma showed pro-inflammatory changes that correlated with plasma metanephrine levels and are ameliorated by adrenalectomy and α-blockade., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: The coexistence of pheochromocytoma and hyperaldosteronism is a rare and clinically significant finding with diagnostic challenges that need to be considered in the workup of patients with hypertension., Case Presentation: This case report describes a 47-year-old Iranian man who initially presented with cold symptoms, chills, and headaches. Despite being diagnosed with panic disorder, his symptoms worsened, leading to a systolic blood pressure crisis. The results indicated elevated levels of 24-hour urine vanillylmandelic acid, metanephrine, and normetanephrine, suggesting increased catecholamine levels. An increase in serum aldosterone was also observed. Further evaluation revealed a 4 cm left adrenal mass and subsequent tests confirmed the diagnosis of pheochromocytoma and hyperaldosteronism. The patient underwent left adrenal gland resection, resulting in complete resolution of symptoms and normalization of test results., Conclusion: This case highlights the importance of considering rare coexisting endocrine disorders in patients presenting with hypertension. Appropriate diagnosis and management of concomitant pheochromocytoma and hyperaldosteronism are crucial for favorable outcomes and may offer insights into potential overlaps in disease pathways., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval is not applicable, and patients’ written informed consent to participate is present. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)