ArticleThe Journal of clinical endocrinology and metabolism2008
Plasma chromogranin A or urine fractionated metanephrines follow-up testing improves the diagnostic accuracy of plasma fractionated metanephrines for pheochromocytoma.
Article in The Journal of clinical endocrinology and metabolism, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 104 citations in OpenAlex.
- Multidisciplinary practice guidelines for the diagnosis, genetic counseling and treatment of pheochromocytomas and paragangliomas.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2021Guideline
- Surgical management of para-aortic paragangliomas: case series of functional and non-functional tumors.International journal of surgery case reports · 2026Article
- Catecholamines and Metanephrines: Quantification in the Diagnosis of Pheochromocytoma and Paraganglioma, Considerations and Critical Issues.Diagnostics (Basel, Switzerland) · 2026Review
- Current Understanding of Carotid Body Paraganglioma Management.Vascular specialist international · 2025Review
- A Laboratory Medicine Perspective on the Investigation of Phaeochromocytoma and Paraganglioma.Diagnostics (Basel, Switzerland) · 2023Review
- The clinical utility of plasma and urine metanephrines in hypertensive emergency.Hormones (Athens, Greece) · 2023Article
- Pheochromocytoma: a changing perspective and current concepts.Therapeutic advances in endocrinology and metabolism · 2023Review
- A Critical Appraisal of Contemporary and Novel Biomarkers in Pheochromocytomas and Adrenocortical Tumors.Biology · 2021Review
- Diagnosis for Pheochromocytoma and Paraganglioma: A Joint Position Statement of the Korean Pheochromocytoma and Paraganglioma Task Force.Endocrinology and metabolism (Seoul, Korea) · 2021Article
- Haemorrhagic retroperitoneal paraganglioma initially manifesting as acute abdomen: a rare case report and literature review.BMC surgery · 2020Review
- Canadian Urological Association Best Practice Report: Long-term surveillance following resection of pheochromocytoma.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2019Article
- The evaluation and treatment of endocrine forms of hypertension.Current cardiology reports · 2014Article
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty.Journal of pediatric endocrinology & metabolism : JPEM · 2014Article
- A Case of Malignant Metastatic Pheochromocytoma After Eight Years of Primary Diagnosis.World journal of oncology · 2014Article
- Pheochromocytoma: an uncommon presentation of an asymptomatic and biochemically silent adrenal incidentaloma.The Malaysian journal of medical sciences : MJMS · 2012Article
- Malignant pheochromocytomas and paragangliomas: a diagnostic challenge.Langenbeck's archives of surgery · 2012Review
- Updated and new perspectives on diagnosis, prognosis, and therapy of malignant pheochromocytoma/paraganglioma.Journal of oncology · 2012Article
- A patient with a large recurrent pheochromocytoma demonstrating the pitfalls of diagnosis.Nature reviews. Endocrinology · 2011Article
- Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness.Endocrinology and metabolism clinics of North America · 2011Review
- Low sensitivity of glucagon provocative testing for diagnosis of pheochromocytoma.The Journal of clinical endocrinology and metabolism · 2010Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
contextThe initial diagnosis of pheochromocytoma relies on plasma fractionated metanephrines levels. Normal levels exclude pheochromocytoma, but positive tests have a low positive predictive value due to the disease's rarity.
objectivesThe objective of the study was to evaluate three approaches to distinguish between true-positive and false-positive tests: 1) increased cutoff for plasma fractionated metanephrines, 2) measurement of serum/plasma chromogranin A (CGA), and 3) urine fractionated metanephrine testing.
designWe studied retrospectively all Mayo Clinic patients with positive plasma fractionated metanephrine tests over a 15-month period and determined their final diagnosis based on histology, imaging, additional biochemical tests, and more than 1 yr follow-up. For a subgroup, urine fractionated metanephrine results were available. All original plasma samples were retested for CGA.
resultsOf 140 patients, 40 had a chromaffin tumor confirmed and 100 excluded, indicating a positive predictive value of plasma fractionated metanephrines of 28.6%. Increasing the threshold for a positive test improved specificity to 98% but missed eight cases (20%). Incorporation of urine fractionated metanephrine testing as follow-up test achieved 80% specificity and 91% sensitivity. The corresponding figures for CGA were 71 and 87% for all patients and 89 and 87% when patients taking proton pump inhibitors were excluded.
conclusionsUnless plasma fractionated metanephrines levels are elevated more than 4-fold above the upper limit of normal, patients with a positive plasma fractionated metanephrines test should be evaluated with urine fractionated metanephrines and serum/plasma CGA assays before being subjected to imaging or invasive diagnostic tests.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.