title: Plasma free metanephrines are superior to urine and plasma catecholamines and urine catecholamine metabolites for the investigation of phaeochromocytoma.
abstract: OBJECTIVE
  To compare the relative diagnostic efficacy of several different tests used to establish a diagnosis of phaeochromocytoma, in patients with a proven diagnosis of phaeochromocytoma, and in hospital patients with significant disease of other types.
  
  
  METHODS
  We prospectively compared biochemical markers of catecholamine output and metabolism in plasma and urine in 22 patients with histologically proven phaeochromocytoma, 15 intensive care unit (ICU) patients, 30 patients on chronic haemodialysis and both hypertensive (n = 10) and normotensive (n = 16) controls.
  
  
  RESULTS
  Receiver operating characteristic curves were plotted. At the point of maximum efficiency, plasma free metanephrines showed 100% sensitivity and 97.6% specificity, compared with plasma catecholamines (78.6% and 70.7%), urine catecholamines (78.6% and 87.8%), urine metanephrines (85.7% and 95.1%), and urine hydroxymethoxymandelic acid (HMMA or VMA) (93.0% and 75.8%). All patients with phaeochromocytoma had plasma free metanephrine concentrations at least 27% above the upper limit of the reference range. Only three other patients (two on haemodialysis and one in ICU) had PFM concentrations more than 50% above the upper limit of the reference range.
  
  
  CONCLUSIONS
  In patients with phaeochromocytoma, plasma free metanephrines displayed superior diagnostic sensitivity and specificity compared with other biochemical markers of catecholamine output and metabolism.
authors.affiliation: Department of Chemical Pathology, Queensland Health Pathology Service, Princess Alexandra Hospital, Woolloongabba, QLD, Australia. peter.hickman@act.gov.au
authors.forename: Peter E
authors.initials: PE
authors.lastname: Hickman
authors.forename: Michelle
authors.initials: M
authors.lastname: Leong
authors.forename: Julia
authors.initials: J
authors.lastname: Chang
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilson
authors.forename: Brett
authors.initials: B
authors.lastname: McWhinney
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis*; D002395:Catecholamines / Q000032:analysis* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008676:Metanephrine / Q000032:analysis*; D008875:Middle Aged; D010673:Pheochromocytoma / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D002395:Catecholamines; D008676:Metanephrine