title: Measurement of urinary metanephrines to screen for pheochromocytoma in an unselected hospital referral population.
abstract: BACKGROUND
  Despite the rarity of pheochromocytoma, diagnosis is important because of the dangers of uncontrolled severe hypertension and the availability of very effective surgical treatment. Urinary or plasma catecholamines or catecholamine derivatives are commonly used to screen for pheochromocytomas before imaging, but data from 24-h urinary metanephrine results, patient age, and sex may better predict tumors in populations with a low pretest probability.
  
  
  METHODS
  We retrospectively studied outcomes of an unselected population (1819 patients) referred to a tertiary hospital laboratory for urinary metanephrine testing and investigated the usefulness of some simple derivative measures for detecting pheochromocytoma. We normalized values for urinary 24-h excretion of metanephrine, normetanephrine, and 3-methoxytyramine by dividing by an age- and sex-specific reference range. We then compared pheochromocytoma prediction by the use of products of these normalized measures with the gold standard of biopsy-confirmed tumor.
  
  
  RESULTS
  The product of the excretion of normalized metanephrine (nMAD) and normalized normetanephrine (nNMT) (nMAD.nNMT) was a highly sensitive (100%) and specific (99.1%) measure, yielding a positive predictive value of 82%. ROC curves were not improved by including the normalized 3-methoxytyramine concentrations in the product. The test for nMAD.nNMT gave higher sensitivity and specificity than the tests for either substance alone.
  
  
  CONCLUSIONS
  The test for nMAD.nNMT is a useful measure for identifying pheochromocytoma in a population with a low pretest probability.
authors.affiliation: Department of Pharmacology, University of Oxford, and Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, United Kingdom. keith.brain@pharm.ox.ac.uk
authors.forename: Keith L
authors.initials: KL
authors.lastname: Brain
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kay
authors.forename: Brian
authors.initials: B
authors.lastname: Shine
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008676:Metanephrine / Q000652:urine*; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012017:Referral and Consultation; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008676:Metanephrine