Abstract

BackgroundFractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma.MethodsWe aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted.ResultsLimitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%–100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%–100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07).ConclusionNegative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.

Highlights

  • The biochemical screening test used for diagnosing pheochromocytoma is institution and laboratory-dependent with variable performance, and an "ideal" test for pheochromocytoma has been sought over the years as false or uninterpretable results are not uncommon with some traditional tests [1,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47]

  • Measurement of fractionated plasma free metanephrines by high performance liquid chromatography and electrochemical detection has been endorsed by investigators at the National Institute of Health (NIH) as the single best test for biochemical screening for pheochromocytoma [48,49,50,51,52,53,54,55,56,57,58,59,60,61]

  • The objective of the current study is to systematically review the literature to determine the diagnostic efficacy of measurements of fractionated plasma metanephrines in detection of pheochromocytoma

Read more

Summary

Introduction

Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. Measurement of fractionated plasma free metanephrines by high performance liquid chromatography and electrochemical detection has been endorsed by investigators at the National Institute of Health (NIH) as the single best test for biochemical screening for pheochromocytoma [48,49,50,51,52,53,54,55,56,57,58,59,60,61]. The objective of the current study is to systematically review the literature to determine the diagnostic efficacy of measurements of fractionated plasma metanephrines in detection of pheochromocytoma

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call