Pheochromocytoma: Positive predictive values of mildly elevated urinary fractionated metanephrines in a large cohort of community‐dwelling patients. Issue 10 (5th September 2019)

• Record Type: Journal Article
• Authors: Hirsch, Dania; Grossman, Alon; Nadler, Varda; Alboim, Sandra; Tsvetov, Gloria
• Is Part Of: Journal of clinical hypertension. Volume 21:Issue 10(2019)
• Page Start: 1527
• Page End: 1533
• Publication Date: 2019-09-05
• Subjects: adrenal incidentaloma -- false positive -- pheochromocytoma -- positive predictive value; Hypertension -- Periodicals; 616.132
• DOI: 10.1111/jch.13657
• Languages: English
• ISSNs: 1524-6175

Abstract

Abstract: The diagnostic utility of different thresholds of elevated urinary fractionated metanephrine (UFM) for pheochromocytoma‐paraganglioma (PPGL) was evaluated in 10 164 community‐dwelling subjects (2012‐2017). Levels were ≥1.5× the upper normal limit (UNL) in 276 subjects (2.7%) and ≥2×UNL in 138 (1.4%). PPGL was subsequently diagnosed in 59 (mean age 51.9 ± 14.3, 64% female); 58 (98.3%) with UFM ≥ 2×UNL. Positive predictive values (PPV) were 42% for UFM ≥ 2×UNL, 55% for UFM ≥ 2.5×UNL, and 69% for UFM ≥ 3×UNL. The main reason for PPGL screening (52.5%) was adrenal incidentaloma. Mean (median) metanephrine/normetanephrine levels were 6.7 ± 9×UNL (3 × UNL) and 6.1 ± 8.9×UNL (2.5 × UNL). Six patients (10.2%) had an extra‐adrenal tumor (one malignant paraganglioma); one had bilateral pheochromocytoma. Only one patient presented with the "classic triad" (headache, palpitations, sweating). In conclusion, after excluding obvious reasons for false‐positive results, thorough diagnostic assessment for PPGL is justified in all subjects with UFM ≥ ×2UNL. The PPV of milder UFM elevations is very low.