title: Phaeochromocytoma with normal urinary catecholamines: the potential value of urinary free metadrenalines.
abstract: BACKGROUND
  Normal urine catecholamine values in patients with phaeochromocytoma is an occasional finding and may lead to a missed diagnosis. Additional urinary free metadrenaline analysis may be of value in this situation.
  
  
  METHODS
  In addition to vanillylmandelic acid, homovanillic acid and the catecholamines, urinary free normetadrenaline (fNMA) and free metadrenaline (fMA) were measured. This report describes six confirmed cases of phaeochromocytoma showing normal urinary catecholamine output and compares fMA results and tumour size with other confirmed cases where the urine catecholamines were increased.
  
  
  RESULTS
  Urine catecholamines in these patients with, on average, smaller tumours, were all normal. Urinary fNMA and fMA were available on five patients, and were increased in three. The data suggest that, unlike the catecholamines, urinary fNMA and fMA could be a useful predictor of tumour size.
  
  
  CONCLUSIONS
  The inclusion of fNMA and fMA in the test profile is likely to be of additional benefit in tumour detection, particularly when catecholamines or other metabolites are normal.
authors.affiliation: Biochemistry Department, Crosshouse Hospital, Kilmamock KA2 OBE, UK. fraser.davidson@aaaht.scot.nhs.uk
authors.forename: D Fraser
authors.initials: DF
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D002395:Catecholamines / Q000302:isolation & purification* / Q000652:urine*; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006719:Homovanillic Acid / Q000378:metabolism; D006801:Humans; D008297:Male; D008676:Metanephrine / Q000652:urine; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000473:pathology / Q000652:urine*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D002395:Catecholamines; D008676:Metanephrine; D006719:Homovanillic Acid