Evidence map›Paper›PMID 37955319›Full record

Observational studyEndocrine-related cancer2024

False-positive results for pheochromocytoma associated with norepinephrine reuptake blockade.

Robin Schürfeld, Christina Pamporaki, Mirko Peitzsch, Nada Rayes, Osama Sabri, Silvio Rohm, Ronald Biemann, Benjamin Sandner, Anke Tönjes, Graeme Eisenhofer

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Endocrine-related cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Quantitative [EJNMMI reports · 2025
    Article
  5. Article
  6. Pitfalls in the Diagnostic Evaluation of Pheochromocytomas.Journal of the Endocrine Society · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Robin SchürfeldDivision of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany.ORCID 0000-0002-7488-916X
Christina PamporakiTU Dresden, Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany.
Mirko PeitzschTU Dresden, Institute of Clinical Chemistry and Laboratory Medicine, Dresden, Germany.
Nada RayesCenter of Surgery, Division of Endocrine Surgery, Department for Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.
Osama SabriDepartment of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
Silvio RohmCenter of Surgery, Department for Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.
Ronald BiemannInstitute of Clinical Chemistry and Laboratory Medicine, University of Leipzig, Leipzig, Germany.
Benjamin SandnerDivision of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany.
Anke TönjesDivision of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany.
Graeme EisenhoferTU Dresden, Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany.ORCID 0000-0002-8601-9903
Leipzig University · DEUniversity Hospital Carl Gustav Carus · DEEv. Diakonissenkrankenhaus Leipzig · DETechnische Universität Dresden · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Measurements of plasma metanephrines and methoxytyramine provide a sensitive test for diagnosis of pheochromocytoma/paraganglioma. False-positive results remain a problem, particularly in patients taking norepinephrine reuptake-blocking drugs. Therefore, in this retrospective observational study, we measured plasma metanephrines and methoxytyramine in 61 patients taking norepinephrine reuptake blockers (tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors) and 17 others taking selective serotonin reuptake inhibitors, all without pheochromocytoma/paraganglioma. We highlight a singular case with strongly elevated plasma normetanephrine and methoxytyramine concentrations associated with norepinephrine reuptake blockade. Data were compared to results from 252 and 1804 respective patients with and without tumors. Plasma normetanephrine was 40% higher (P < 0.0001) in patients on norepinephrine reuptake blockers and methoxytyramine was 127% higher (P = 0.0062) in patients taking tricyclic antidepressants compared to patients not taking uptake blockers and without tumors. The corresponding false-positive rates rose (P < 0.0001) from 4.8% to 23.0% for normetanephrine and from 0.9% to 28.6% for methoxytyramine. Selective serotonin reuptake inhibitors did not increase plasma concentrations of metabolites. In the highlighted case, plasma normetanephrine and methoxytyramine were elevated more than six times above upper reference limits. A pheochromocytoma/paraganglioma, however, was excluded by functional imaging. All biochemical test results normalized after discontinuation of norepinephrine reuptake blockers. These findings clarify that norepinephrine reuptake blockers usually result in mild elevations of normetanephrine and methoxytyramine that, nevertheless, significantly increase the number of false-positive results. There can, however, be exceptions where increases in normetanephrine and methoxytyramine reach pathological levels. Such exceptions may reflect failure of centrally mediated sympathoinhibition that normally occurs with the norepinephrine reuptake blockade.

Indexed as

Adrenal Gland NeoplasmsParagangliomaPheochromocytomaAntidepressive Agents, TricyclicDopamineHumansMetanephrineNorepinephrineNormetanephrineSelective Serotonin Reuptake Inhibitors3-methoxytyramineAntidepressive Agents, TricyclicDopamineMetanephrineNorepinephrineNormetanephrineSelective Serotonin Reuptake Inhibitorsclonidinedoxepinduloxetinefalse-positivemetanephrinemetanephrinesmethoxytyraminenormetanephrinepheochromocytomaserotonin–norepinephrine reuptake inhibitortricyclic antidepressant

Identifiers

PMID37955319
PMCPMC10762534
OpenAlexW4388639793

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.