1. Pheochromocytoma: Positive predictive values of mildly elevated urinary fractionated metanephrines in a large cohort of community-dwelling patients.
- Author
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Hirsch D, Grossman A, Nadler V, Alboim S, and Tsvetov G
- Subjects
- Adrenal Gland Neoplasms diagnosis, Adrenal Gland Neoplasms epidemiology, Adrenal Gland Neoplasms metabolism, Adult, Aged, Cohort Studies, Female, Humans, Hypertension diagnosis, Hypertension epidemiology, Independent Living statistics & numerical data, Israel epidemiology, Male, Middle Aged, Paraganglioma diagnosis, Paraganglioma metabolism, Paraganglioma pathology, Pheochromocytoma metabolism, Pheochromocytoma pathology, Predictive Value of Tests, Retrospective Studies, Adrenal Gland Neoplasms pathology, Hypertension etiology, Metanephrine urine, Pheochromocytoma diagnosis
- Abstract
The diagnostic utility of different thresholds of elevated urinary fractionated metanephrine (UFM) for pheochromocytoma-paraganglioma (PPGL) was evaluated in 10 164 community-dwelling subjects (2012-2017). Levels were ≥1.5× the upper normal limit (UNL) in 276 subjects (2.7%) and ≥2×UNL in 138 (1.4%). PPGL was subsequently diagnosed in 59 (mean age 51.9 ± 14.3, 64% female); 58 (98.3%) with UFM ≥ 2×UNL. Positive predictive values (PPV) were 42% for UFM ≥ 2×UNL, 55% for UFM ≥ 2.5×UNL, and 69% for UFM ≥ 3×UNL. The main reason for PPGL screening (52.5%) was adrenal incidentaloma. Mean (median) metanephrine/normetanephrine levels were 6.7 ± 9×UNL (3 × UNL) and 6.1 ± 8.9×UNL (2.5 × UNL). Six patients (10.2%) had an extra-adrenal tumor (one malignant paraganglioma); one had bilateral pheochromocytoma. Only one patient presented with the "classic triad" (headache, palpitations, sweating). In conclusion, after excluding obvious reasons for false-positive results, thorough diagnostic assessment for PPGL is justified in all subjects with UFM ≥ ×2UNL. The PPV of milder UFM elevations is very low., (©2019 Wiley Periodicals, Inc.)
- Published
- 2019
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