Biochemical tests for pheochromocytoma: strategies in hypertensive patients.
OBJECTIVE
To determine the optimal clinical strategy utilizing either 1) serum catecholamines, 2) urinary metanephrines, or 3) urinary vanillylmandelic acid measurements in the evaluation of hypertensive patients with suspected pheochromocytoma.


METHODS
Prospective clinical determination of test-operating characteristics.


METHODS
Tertiary care university medical center.


METHODS
415 patients referred for evaluation of suspected pheochromocytoma.


METHODS
All subjects had measurements of the three above-mentioned biochemical tests with the diagnosis of pheochromocytoma established by tissue confirmation.


RESULTS
All three biochemical tests were similar in sensitivity (0.70-0.75), specificity (0.90-0.95), and receiver operating characteristics. With an estimated disease prevalence of 5.9% in symptomatic hypertensive patients, the predictive value of any single negative test would be 98% in ruling out disease.


CONCLUSIONS
All three biochemical tests have similar performance characteristics and only a single test need be performed to exclude pheochromocytoma in most symptomatic hypertensive patients in a primary care population.
Young
M J
MJ
Department of Internal Medicine, Medical College of Wisconsin, Milwaukee 53226.
Dmuchowski
C
C
Wallis
J W
JW
Barnas
G P
GP
Shapiro
B
B
D019797:3-Iodobenzylguanidine; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D002395:Catecholamines / Q000097:blood*; D004837:Epinephrine / Q000031:analogs & derivatives* / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D007462:Iodobenzenes; D008676:Metanephrine / Q000652:urine*; D009638:Norepinephrine / Q000097:blood; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013565:Sympatholytics; D014642:Vanilmandelic Acid / Q000652:urine*
D002395:Catecholamines; D007462:Iodobenzenes; D013565:Sympatholytics; D019797:3-Iodobenzylguanidine; D008676:Metanephrine; D014642:Vanilmandelic Acid; D009638:Norepinephrine; D004837:Epinephrine