Abstract
Background: Pheochromocytoma is a rare adrenaline-producing tumour that arises from adrenal gland. The number of cases are increasing globally each year. Pheochrmocytomas release a hormone called adrenaline which can cause severe health problems such as hypertension (high blood pressure), heart attack, and stroke. They might lead to death if not diagnosed early. Diagnosis of pheochromocytomas can be performed by different biochemical tests like catecholamines, metanephrines, chromogranin A …etc.
Objective: To determine the efficacy of plasma free metanephrines measurements for inclusion and confirmation of pheochromocytoma.
Methods: Multiple electronic searches were carried out to determine studies in the English-language. Databases used for this purpose were CINHAL, AMED, MEDLINE, PubMed, ScienceDirect, Google scholar and the Cochrane library. To identify relevant articles, various key terms were used. The articles obtained were published during or after 2005. Moreover, inclusion and exclusion criteria were applied while performing this search. The intervention was plasma free metanephrines and comparison with other biochemical test such as plasma or urinary catecholamines, urinary metanephrines, chromogranin A and deconjugated plasma metanephrines.
Results: From forty-four studies, only seven studies corresponded with inclusion and exclusion criteria. The main results of four studies showed that plasma free metanephrines were highly efficient in the diagnosis of pheochrmocytoma compared to plasma catecholamines, epinephrines, urine metanephrines and plasma deconjugated metanephrines. The remaining three studies were displayed totally different findings. Urinary metanephrine, chromogranin A and urinary catecholamines demonstrated high sensitivities and specificities compared to plasma free metanephrines. Certain procedures like fast, abstinence from drugs; supine position should be followed by participants before and during blood and urine collection.
Conclusion: Plasma free metanephrines measurements are preferable (superior) in the diagnosis of pheochromocytoma. However, patients need to fast, abstinence from drugs, avoid caffeinated and decaffeinated beverages and blood should be collected in the supine position.
References
- Aveyard, H. 2007, “A suggested structure” in: Doing a literature review in health and social care: a practical guide, Open University Press, Maidenhead. pp. 148- 151.
- Christensen, T. T., Frystyk, J., & Poulsen, P. L., “Comparison of plasma metanephrines measured by a commercial immunoassay and urinary catecholamines in the diagnosis of pheochromocytoma”, Scandinavian Journal of Clinical & Laboratory Investigation, no. 71, pp. 695-700.
- Grouzmann, E., Drouard-Troalen, L., Baudin, E., Pierre-Francois, P., Muller, B., Daniela, G., et al. 2010, “Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma”, European Journal of Endocrinology, no. 162, pp. 951-960.
- Herbomez, M., Forzy, G., Bauters, C., Tierny, C., Pigny, P., Carnaille, B., et al. 2007, “An analysis of the biochemical diagnosis of 66 pheochromocytoma”, European Journal of Endocrinology, no. 156, pp. 569-575.
- Hickman, P., Leong, M., Chang, J., Susan, R., & McWhinney, B. 2009, “Plasma free metanephrines are superior to urine and plasma catecholamines and urine catecholamine metabolites for the investigation of pheochromocytoma”, The Journal of Pathology, vol. 41, no. 2, pp. 173-177.
- Jacques, W. M., Karel Pacak, McClellan, M., Marston Linehan, W., Massimo Mannelli, Peter Friberg, et al, 2002, “Biochemical Diagnosis of Pheochromocytoma, Which Test Is Best?”, The Journal of the American Medical Association, vol. 287, no. 11, pp. 1427-1434.
- Omeprazole, 2014, [online]. Available from: http://www.drugs.com/omeprazole.html [Accessed 25 March 2014].
- Pamporaki, C., Darr, R., Bursztyn, M., Glockner, S., Bornstein, S. R., Lenders, J. W. M., et al. 2013, “Plasma-free vs deconjugated metanephrines for diagnosis of pheochromocytoma”, Clinical Endocrinology, no. 79, pp. 476-483.
- Pheochromocytoma (adrenaline-producing adrenal tumor), 2014, [online]. Available from: http://endocrinediseases.org/adrenal/pheochromocytoma.shtml [Accessed 25 March 2014].
- Pheochromocytoma and diabetes mellitus, 2014 [online]. Available from: http://www.diapedia.org/other-types-of-diabetes-mellitus/phaeochromocytoma-and-diabetes-mellitus [Accessed 1st April 2014].
- Procopiou, M., Finney, H., Akker, S. A., Chew, S. L., Drake, W. M., Burrin, J. 2009, “Evaluation of an enzyme immunoassay for plasma-free metanephrines in the diagnosis of catecholamine-secreting tumors”, European Journal of Endocrinology, no. 161, pp. 131-140.
- Pheochromocytoma, 2014, 2014, [online]. Available from: http://www.nlm.nih.gov/medlineplus/pheochromocytoma.html [Accessed 25 March 2014].
- Sanath, K., Rohit, D., Nicholas, W., El-Shafie, O., & Karin, N. 2014, “Successful Management of Pheochromocytoma using Preoperative Oral Labetalol and Intraoperative Management Sulphate”, Sultan Qaboos University Medical Journal, vol. 14, no. 2, pp. 236-240.
- Scottish Intercollegiate Guidelines Network (SIGN), 2014, [online]. Available from: http://www.sign.ac.uk/methodology/checklists.html [Accessed 25 March 2014].
- Vaclavik, J., Stejskal, D., Lacnak, B., Lazarova, M., Jedelsky, L., Kadalova, L., et al. 2007, “Free plasma metanephrines as a screening test for pheochromocytoma in low-risk patients”, Journal of Hypertension, vol. 25, no. 7, pp. 1427-1431.
- Yogish, C., Kudva, Anna, M., Sawka, William, F., & Young, J. R., 2003, “The Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience”, The Journal of Clinical Endocrinology & metabolism, vol. 88, no. 10, pp. 4533-4539.
Corresponding Author
Dr Hassan Sadek
Senior Consultant Lecturer, Oman College of Heath Sciences, Ministry of Health, Oman
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.39
