title: Measurements of plasma metanephrines by immunoassay vs liquid chromatography with tandem mass spectrometry for diagnosis of pheochromocytoma.
abstract: BACKGROUND
  Reports conflict concerning measurements of plasma metanephrines (MNs) for diagnosis of pheochromocytomas/paragangliomas (PPGLs) by immunoassays compared with other methods. We aimed to compare the performance of a commercially available enzyme-linked immunoassay (EIA) kit with liquid chromatography-tandem mass spectrometric (LC-MS/MS) measurements of MNs to diagnose PPGLs.
  
  
  METHODS
  In a substudy of a prospective, multicenter trial to study the biochemical profiles of monoamine-producing tumors, we included 341 patients (174 males and 167 females) with suspected PPGLs (median age 54 years), of whom 54 had confirmed PPGLs. Plasma MNs were measured by EIA and LC-MS/MS, each in a specialized laboratory.
  
  
  RESULTS
  Plasma normetanephrine (NMN) and MN were measured 60 and 39% lower by EIA than by LC-MS/MS. Using upper cut-offs stipulated for the EIA, diagnostic sensitivity was only 74.1% at a specificity of 99.3%. In contrast, use of similar cut-offs for MN and overall lower age-adjusted cut-offs for NMN measured by LC-MS/MS returned a diagnostic sensitivity and specificity of 98.1 and 99.7%. Areas under receiver-operating characteristic curves, nevertheless, indicated comparable diagnostic performance of the EIA (0.993) and LC-MS/MS (0.985). Diagnostic sensitivity for the EIA increased to 96.2% with a minimal loss in specificity (95.1%) following use of cut-offs for the EIA adapted to correct for the negative bias.
  
  
  CONCLUSIONS
  The EIA underestimates plasma MNs and diagnostic sensitivity is poor using commonly stipulated cut-offs, resulting in a high risk for missing patients with PPGLs. Correction of this shortcoming can be achieved by appropriately determined cut-offs resulting in comparable diagnostic performance of EIA and LC-MS/MS assays.
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresd
authors.forename: Dirk
authors.initials: D
authors.lastname: Weismann
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Peitzsch
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Raida
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Gosk
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Riester
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Holger S
authors.initials: HS
authors.lastname: Willenberg
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Klemm
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Manz
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Deutschbein
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kroiss
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Därr
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresd
authors.forename: Graeme
authors.initials: G
authors.lastname: Eisenhofer
authors.affiliation: Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Endocrine and Diabetes UnitDepartment of Internal Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, GermanyComprehensive Heart Failure CenterUniversity of Würzburg, Würzburg, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Munich, GermanyDivision for Specific EndocrinologyDepartment of Endocrinology and Diabetology, Medical Faculty, University Dusseldorf, Dusseldorf, GermanyLDN Labor Diagnostika Nord GmbH und Co. KGNordhorn, GermanyCentral Laboratory of the University Hospital of WuerzburgWürzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresd
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002853:Chromatography, Liquid; D005260:Female; D006801:Humans; D007118:Immunoassay; D007124:Immunoenzyme Techniques; D008297:Male; D008676:Metanephrine / Q000097:blood*; D008875:Middle Aged; D010673:Pheochromocytoma / Q000097:blood*; D011446:Prospective Studies; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D008676:Metanephrine