title: Diagnosing phaeochromocytoma/paraganglioma in a patient presenting with critical illness: biochemistry versus imaging.
abstract: Phaeochromocytomas and paragangliomas (PPGLs) are revealed by acute cardiovascular complications involving end-organ damage in up to 20% of cases, a presentation associated with particularly high risk for mortality. Among such cases, PPGLs should be considered in patients with unexplained left ventricular failure, multi-organ failure, hypertensive crises or shock. The diagnosis of PPGL commonly relies on measurements of metanephrines in plasma or urine. However, acute critical illness is usually associated with sympathoadrenal activation. Thus, levels of metanephrines in patients in an acute emergency or intensive care setting, whether treated or not with vasoactive drugs, usually cannot be used to reliably diagnose PPGL. Delays in provision of diagnostic test results, particularly when these require 24-h urine collections, may also be incompatible for any need for rapid decisions on patient management or therapeutic interventions. The acute emergency situation therefore represents one exception to the rule where imaging studies to search for a PPGL may be undertaken without biochemical evidence of a catecholamine-producing tumour.
authors: Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité D'hypertension Artérielle, Paris Cedex 15, France.
authors: Laurence
authors: L
authors: Amar
authors: Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Graeme
authors: G
authors: Eisenhofer
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D016638:Critical Illness; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D008676:Metanephrine / Q000097:blood / Q000652:urine; D010235:Paraganglioma / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D010673:Pheochromocytoma / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D008676:Metanephrine