ArticleAnnals of clinical biochemistry2013
Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma.
Article in Annals of clinical biochemistry, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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Who cites it
32 citing papers in PubMed, 110 citations in OpenAlex.
- Catecholamine metabolism revisited: from neurochemistry to integrative physiology and pathophysiology.Physiological reviews · 2026Review
- Determinants of false-positive plasma free metanephrines and methoxytyramine: the role of medications and chronic disease.Endocrine-related cancer · 2026Review
- Muscle Loss Driven by Extracellular Signal-Regulated Kinase Suppression via β-Adrenergic Activation in High-Normal Catecholamine Status.Endocrinology and metabolism (Seoul, Korea) · 2026Article
- Metoclopramide-Induced Pheochromocytoma Crisis: A Case Report and Literature Review.Clinical case reports · 2026Article
- Urine and plasma metanephrine concentrations in cats with chronic kidney disease: characterization and correlation with biomarkers of renal function.Journal of veterinary internal medicine · 2026Article
- Natural history of large adrenal tumors.Frontiers in endocrinology · 2026Article
- Plasma-Free Metanephrine and Normetanephrine Quantification for Clinical Applications Validated by Combining Solid-Phase Extraction and HPLC-MS/MS.Molecules (Basel, Switzerland) · 2025Article
- Secondary Hypertension in Children-Identifying and Investigating at Risk Children.Current hypertension reports · 2025Review
- Pitfalls in the Diagnostic Evaluation of Pheochromocytomas.Journal of the Endocrine Society · 2024Article
- Small Incidental Pheochromocytoma Presenting With Normal or Borderline High 24-hour Urine Fractionated Metanephrines.JCEM case reports · 2024Article
- Article
- The level of accordance between preoperative and postoperative diagnosis in patients undergoing adrenalectomy - a study of 230 consecutive cases.Archives of medical science : AMS · 2024Article
- False-positive results for pheochromocytoma associated with norepinephrine reuptake blockade.Endocrine-related cancer · 2024Observational
- A Laboratory Medicine Perspective on the Investigation of Phaeochromocytoma and Paraganglioma.Diagnostics (Basel, Switzerland) · 2023Review
- Quantitative analysis of catecholamines and their metabolites in 491 patients with adrenal tumors: a retrospective single-center cohort study.Journal of cancer research and clinical oncology · 2023Article
- Reference intervals for plasma, urinary, and salivary concentrations of free metanephrines in dogs: Relevance to the diagnosis of pheochromocytoma.Journal of veterinary internal medicine · 2023Article
- Editorial: Predictive tools in pheochromocytoma and paraganglioma.Frontiers in endocrinology · 2023Article
- [European radiology · 2022Article
- Diagnostic Accuracy of Salivary Metanephrines in Pheochromocytomas and Paragangliomas.Clinical chemistry · 2021Article
- A high sensitivity LC-MS/MS method for measurement of 3-methoxytyramine in plasma and associations between 3-methoxytyramine, metanephrines, and dopamine.Journal of mass spectrometry and advances in the clinical lab · 2021Article
Corrections and comments
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Authors and funding
16 authors at 5 institutions in 4 countries.
Funding
Abstract
backgroundMeasurements of plasma normetanephrine and metanephrine provide a useful diagnostic test for phaeochromocytoma, but this depends on appropriate reference intervals. Upper cut-offs set too high compromise diagnostic sensitivity, whereas set too low, false-positives are a problem. This study aimed to establish optimal reference intervals for plasma normetanephrine and metanephrine.
methodsBlood samples were collected in the supine position from 1226 subjects, aged 5-84 y, including 116 children, 575 normotensive and hypertensive adults and 535 patients in whom phaeochromocytoma was ruled out. Reference intervals were examined according to age and gender. Various models were examined to optimize upper cut-offs according to estimates of diagnostic sensitivity and specificity in a separate validation group of 3888 patients tested for phaeochromocytoma, including 558 with confirmed disease.
resultsPlasma metanephrine, but not normetanephrine, was higher (P < 0.001) in men than in women, but reference intervals did not differ. Age showed a positive relationship (P < 0.0001) with plasma normetanephrine and a weaker relationship (P = 0.021) with metanephrine. Upper cut-offs of reference intervals for normetanephrine increased from 0.47 nmol/L in children to 1.05 nmol/L in subjects over 60 y. A curvilinear model for age-adjusted compared with fixed upper cut-offs for normetanephrine, together with a higher cut-off for metanephrine (0.45 versus 0.32 nmol/L), resulted in a substantial gain in diagnostic specificity from 88.3% to 96.0% with minimal loss in diagnostic sensitivity from 93.9% to 93.6%.
conclusionsThese data establish age-adjusted cut-offs of reference intervals for plasma normetanephrine and optimized cut-offs for metanephrine useful for minimizing false-positive results.
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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.