Abstract
The biochemical features of two patients with phaeochromocytomas illustrate the inadvisability of depending on a single group of analytes for the diagnosis. The first case presented as a surgical emergency with retroperitoneal haemorrhage. Biochemical diagnosis was difficult since total 24 hour urinary free catecholamine excretion was within normal limits in two out of three samples, and only marginally raised in the third with an atypical preponderance of adrenaline. Plasma catecholamine concentrations were also normal. But urinary excretion of the catecholamine metabolites, metadrenaline and 4-hydroxy-3-methoxy mandelic acid (HMMA), was consistently raised. In contrast, the second patient presenting with headache and labile hypertension showed normal metabolite excretion in the face of grossly increased free noradrenaline excretion and raised plasma noradrenaline concentrations. It is therefore recommend that, as well as urinary free catecholamines, one group of their main metabolites, the 3-methoxy amines (normetadrenaline and metadrenaline) or HMMA, should routinely be measured whenever a phaeochromocytoma is suspected.
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Selected References
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- Engelman K. Principles in the diagnosis of pheochromocytoma. Bull N Y Acad Med. 1969 Sep;45(9):851–858. [PMC free article] [PubMed] [Google Scholar]
- Green B., Cooper J. D., Turnell D. C. An automated method for the analysis of urinary free catecholamines using ASTED and high-pressure liquid chromatography. Ann Clin Biochem. 1989 Jul;26(Pt 4):361–367. doi: 10.1177/000456328902600412. [DOI] [PubMed] [Google Scholar]
- Sinclair D., Shenkin A., Lorimer A. R. Normal catecholamine production in a patient with a paroxysmally secreting phaeochromocytoma. Ann Clin Biochem. 1991 Jul;28(Pt 4):417–419. doi: 10.1177/000456329102800420. [DOI] [PubMed] [Google Scholar]
- Smythe G. A., Edwards G., Graham P., Lazarus L. Biochemical diagnosis of pheochromocytoma by simultaneous measurement of urinary excretion of epinephrine and norepinephrine. Clin Chem. 1992 Apr;38(4):486–492. [PubMed] [Google Scholar]
- Sutton M. G., Sheps S. G., Lie J. T. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354–360. [PubMed] [Google Scholar]
- Tucker R. M., Labarthe D. R. Frequency of surgical treatment for hypertension in adults at the Mayo Clinic from 1973 through 1975. Mayo Clin Proc. 1977 Sep;52(9):549–545. [PubMed] [Google Scholar]
- Weinkove C. ACP Broadsheet No 127: April 1991. Measurement of catecholamines and their metabolites in urine. J Clin Pathol. 1991 Apr;44(4):269–275. doi: 10.1136/jcp.44.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]