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Extended matching item (EMI)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Plasma metanephrine has a higher sensitivity (96%) but lower specificity (85%) compared to 24-hour urinary collection for catecholamines and metanephrines (sensitivity 87.5%, specificity of 99.7%). High-risk patients (those with a predisposing syndrome, or a family / personal history of a pheochromocytoma) are screened by the more sensitive plasma metanephrine testing. Patients at lower risk, but with suggestive symptoms (flushing spells, hypertension) are screened with the more specific 24-hour urine collection for catecholamines and metanephrines.
Endocrine tumours
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Michael Skinner, Eduardo Perez
The signs and symptoms associated with phaeochromocytomas in patients with MEN2 are due to paroxysmal hypertension, which can be extreme and episodic, with systolic blood pressure readings greater than 250 mmHg. Occasionally, patients present with catecholamine-induced cardiomyopathy and hypertensive encephalopathy. Also, orthostatic hypotension, when present, is suggestive of MEN2. Laboratory confirmation is similar to sporadic phaeochromocytoma, especially the finding of increased plasma metanephrine. Once established, bilateral disease should be excluded with the use of MRI imaging.
Case 49: A Teenager with Palpitations
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
When he attended outpatient clinic, the patient was noted to have markedly elevated plasma metanephrine levels, indicative of a phaeochromocytoma. A magnetic resonance imaging (MRI) scan of the adrenals was performed – this imaging modality was favoured over an abdominal computed tomography (CT) in this instance to avoid exposing such a young patient to ionising radiation. The MRI scan showed a left-sided adrenal mass, consistent with a phaeochromocytoma.
An adrenal cortical adenoma with neuroendocrine-type granules mimicking pheochromocytoma
Published in Ultrastructural Pathology, 2023
Leonardo Rossi, Carlo Enrico Ambrosini, Liborio Torregrossa, Maria Margherita de Santi, Raffaella Guazzo, Tommaso Simoncini, Alessandra Bacca, Benard Gjeloshi, Francesco Pignatelli, Mattia Iachini, Elisa Loguercio, Chiara Becucci, Gabriele Materazzi
A 59-year-old woman with a medical history of hypertension, hypertensive cardiopathy, severe obesity and Obstructive Sleep Apnea Syndrome (OSAS) was under follow-up since 2017 for a left adrenal nodule. Due to the increase of catecholamine secretion (24 h urinary normetanephrine 1407.6 mcg, 24 h urinary metanephrine 8.1 mcg), in 2019 the patient underwent Metaiodobenzylguanidine (MIBG) scintigraphy that resulted negative. Notwithstanding, later on the patient complained that her blood pressure had become difficult to control and laboratory evaluation revealed a progressive increase of 24 h urinary normetanephrine (3016 mcg/24 h), with normal level of metanephrine (20.0 mcg/24 h). The patient underwent computed tomography which confirmed a 15-mm nodule of the left adrenal gland with benign contrast-enhancement features; besides, a 25-mm tumor of uterus was documented. Hysteroscopy was performed with uterine endometrial biopsy, which revealed a well-differentiated endometrioid endometrial adenocarcinoma. With the presumptive diagnosis of pheochromocytoma associated with endometrioid endometrial adenocarcinoma, a laparoscopic left adrenalectomy along with hysteroannessiectomy was scheduled.
The effect of acid use as a preservative on the results of biochemical tests measured in 24-h urine
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Ceylan Bal, Canan Topcuoğlu, Ahmet Rıfat Balık, Fatma Meriç Yılmaz, Özcan Erel, Gülsen Yılmaz
In terms of mean percent differences for adrenaline and noradrenaline, the parameters in which acid use is recommended as a preservative, the difference between groups B and E from group A was greater than the difference between groups C and D (although the difference between groups B and E for adrenaline was less than 10%). Willemsen et al. found low varying concentrations of adrenaline in 3 of 8 samples and noradrenaline in 4 of 8 samples stored at room temperature without preservatives after 24 h [21]. In other studies in the literature, it was reported that the catecholamine concentration decreased within 24 h. Most of these studies are studies conducted with a limited number of individuals or by creating a urine pool [22–24]. The limited number of studies evaluating metanephrines found no significant difference in metanephrine concentrations in treated and untreated samples [11,21,25]. In our study, there was no significant difference in all of the other groups when compared with the group that we accepted as a reference.
Intrarenal hemodynamics and kidney function in pheochromocytoma and paraganglioma before and after surgical treatment
Published in Blood Pressure, 2021
Magdalena Januszewicz, Piotr Dobrowolski, Andrzej Januszewicz, Ewa Warchoł-Celińska, Katarzyna Jóźwik-Plebanek, Daria Motyl, Marek Kabat, Mariola Pęczkowska, Ilona Michałowska, Urszula Ambroziak, Sadegh Toutounchi, Zbigniew Gałązka, Louisiane Courcelles, Marco Pappaccogli, Graeme Eisenhofer, Alexandre Persu, Jacques W. M. Lenders, Jacek Kądziela, Aleksander Prejbisz
Catecholamine biochemical phenotypes were assessed based on relative tumour-derived increases in plasma concentrations of normetanephrine, metanephrine, and methoxytyramine. Tumour-derived increments were calculated by subtracting from the concentration of each metabolite in each patient with a PPGL the mean concentration of the corresponding metabolites- normetanephrine (52 pg/mL), metanephrine (26 pg/mL) and methoxytyramine (5 pg/mL) in a previously described reference group [14]. We defined adrenergic tumours as those exhibiting both an increase in plasma metanephrine above a predefined cut-off (62 pg/mL) and a tumour-derived increment of metanephrine larger than 5% of combined increments of all O-methylated metabolites. We defined all other tumours as non-adrenergic, including both noradrenergic and dopaminergic tumors [15]. Within the non-adrenergic group only one patient was characterised by solitary increased secretion of dopamine but not of noradrenaline nor adrenaline.