Pheochromocytoma laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of pheochromocytoma include elevated | Laboratory findings consistent with the diagnosis of pheochromocytoma include elevated 24-hour urinary fractionated catecholamines and metanephrines for low risk patients and plasma fractionated metanephrines for high risk ones. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
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* Elevated plasma and urinary [[catecholamine]]s and [[metanephrine]]s | * Elevated plasma and urinary [[catecholamine]]s and [[metanephrine]]s | ||
* Elevated urinary [[vanillyl mandelic acid]] | * Elevated urinary [[vanillyl mandelic acid]] | ||
'''Indications of pheochromocytoma testing''': | '''Indications of pheochromocytoma testing''':<ref name="pmid17121518">{{cite journal| author=Gimenez-Roqueplo AP, Lehnert H, Mannelli M, Neumann H, Opocher G, Maher ER et al.| title=Phaeochromocytoma, new genes and screening strategies. | journal=Clin Endocrinol (Oxf) | year= 2006 | volume= 65 | issue= 6 | pages= 699-705 | pmid=17121518 | doi=10.1111/j.1365-2265.2006.02714.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17121518 }}</ref> | ||
* Triad of tachycardia, headache, and sweating. | * Triad of tachycardia, headache, and sweating. | ||
* Episodes of palpitation, headache and tremors for unknown reasons. | * Episodes of palpitation, headache and tremors for unknown reasons. | ||
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* A family history of pheochromocytoma, , multiple endocrine neoplasia type 2, neurofibromatosis type 1, or von Hippel-Lindau. | * A family history of pheochromocytoma, , multiple endocrine neoplasia type 2, neurofibromatosis type 1, or von Hippel-Lindau. | ||
* Presence of bilateral, extra-adrenal or multiple tumours or a malignant tumour, should be seen as indications for genetic testing. | * Presence of bilateral, extra-adrenal or multiple tumours or a malignant tumour, should be seen as indications for genetic testing. | ||
* An incidentally discovered adrenal mass that does not have imaging characteristics consistent with pheochromocytoma. | |||
'''High risk patients''': plasma fractionated metanephrines is the first test, if elevated; 24-hour urinary fractionated metanephrines, catecholamines, and imaging shuld be the second test for diagnosis. <ref name="pmid11903030">{{cite journal| author=Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P et al.| title=Biochemical diagnosis of pheochromocytoma: which test is best? | journal=JAMA | year= 2002 | volume= 287 | issue= 11 | pages= 1427-34 | pmid=11903030 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11903030 }}</ref> | |||
High risk patients include: family history of MEN2 and VHL syndrome or past history of pheochromocytoma. | |||
'''Low risk patients''': 24-hour urinary fractionated catecholamines and metanephrines.<ref name="pmid12574179">{{cite journal| author=Sawka AM, Jaeschke R, Singh RJ, Young WF| title=A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. | journal=J Clin Endocrinol Metab | year= 2003 | volume= 88 | issue= 2 | pages= 553-8 | pmid=12574179 | doi=10.1210/jc.2002-021251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12574179 }}</ref> | |||
'''NB''': Discontinue TCAs two weeks before any hormonal assessments because they interrupt 24-hour urinary catecholamines metabolism.<ref name="pmid171215182">{{cite journal| author=Gimenez-Roqueplo AP, Lehnert H, Mannelli M, Neumann H, Opocher G, Maher ER et al.| title=Phaeochromocytoma, new genes and screening strategies. | journal=Clin Endocrinol (Oxf) | year= 2006 | volume= 65 | issue= 6 | pages= 699-705 | pmid=17121518 | doi=10.1111/j.1365-2265.2006.02714.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17121518 }}</ref> | |||
==References== | ==References== | ||
Revision as of 14:52, 3 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
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Overview
Laboratory findings consistent with the diagnosis of pheochromocytoma include elevated 24-hour urinary fractionated catecholamines and metanephrines for low risk patients and plasma fractionated metanephrines for high risk ones.
Laboratory Findings
Diagnostic lab findings associated with pheochromocytoma include:
- Elevated plasma and urinary catecholamines and metanephrines
- Elevated urinary vanillyl mandelic acid
Indications of pheochromocytoma testing:[1]
- Triad of tachycardia, headache, and sweating.
- Episodes of palpitation, headache and tremors for unknown reasons.
- Hypertension at age <20 years), resistant hypertension.
- A family history of pheochromocytoma, , multiple endocrine neoplasia type 2, neurofibromatosis type 1, or von Hippel-Lindau.
- Presence of bilateral, extra-adrenal or multiple tumours or a malignant tumour, should be seen as indications for genetic testing.
- An incidentally discovered adrenal mass that does not have imaging characteristics consistent with pheochromocytoma.
High risk patients: plasma fractionated metanephrines is the first test, if elevated; 24-hour urinary fractionated metanephrines, catecholamines, and imaging shuld be the second test for diagnosis. [2]
High risk patients include: family history of MEN2 and VHL syndrome or past history of pheochromocytoma.
Low risk patients: 24-hour urinary fractionated catecholamines and metanephrines.[3]
NB: Discontinue TCAs two weeks before any hormonal assessments because they interrupt 24-hour urinary catecholamines metabolism.[4]
References
- ↑ Gimenez-Roqueplo AP, Lehnert H, Mannelli M, Neumann H, Opocher G, Maher ER; et al. (2006). "Phaeochromocytoma, new genes and screening strategies". Clin Endocrinol (Oxf). 65 (6): 699–705. doi:10.1111/j.1365-2265.2006.02714.x. PMID 17121518.
- ↑ Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P; et al. (2002). "Biochemical diagnosis of pheochromocytoma: which test is best?". JAMA. 287 (11): 1427–34. PMID 11903030.
- ↑ Sawka AM, Jaeschke R, Singh RJ, Young WF (2003). "A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines". J Clin Endocrinol Metab. 88 (2): 553–8. doi:10.1210/jc.2002-021251. PMID 12574179.
- ↑ Gimenez-Roqueplo AP, Lehnert H, Mannelli M, Neumann H, Opocher G, Maher ER; et al. (2006). "Phaeochromocytoma, new genes and screening strategies". Clin Endocrinol (Oxf). 65 (6): 699–705. doi:10.1111/j.1365-2265.2006.02714.x. PMID 17121518.