The interassay imprecision for 2 concentrations of
metanephrine (0.23 and 1.10 nmol/L) was 8.3% and 4.3% for the MRM method and 9.9% and 6.1% for the [MRM.sup.3] method (n = 10), respectively.
Urinary and blood excretion of cat-echolamines and
metanephrine was normal.
Drugs and pheochromocytoma--don't be fooled by every elevated
metanephrine. NEJM 2011; 364: 226870.
Her 24 hour urinary vanillin mandelic acid level was 22.2mg/24hrs (1-13.6 mg/24hrs), 24 hour urinary
metanephrine was 188.2 [micro]g/24hrs (<350 [micro]g/24hrs), and 24 hour urinary normetanephrine was 653 [micro]g/24hrs (<600 [micro]g/24hrs).
2A), noradrenaline (norepinephrine),
metanephrine, dopamine, and eicosanoids (Fig.
Biochemical evaluation revealed elevated urinary catecholamines (urine dopamie 735 umol/molCr [normal 175-735]; urine epinephrine 23.3 umol/molCr [normal 2.5-1.3]; urine norepinephrine 72 umol/molCr [normal 14-56]) and normal urine
metanephrines (urine
metanephrine 0.114 mmol/molCr [normal 0.023-0.302]; urine normetanephrine 0.353 mmol/molCr [normal 0.216-0.787]).
Time after initiation of antifungal treatments Time of the 2 months 4 months diagnosis ACTH (pg/mL) 131.3 4.6 28.1 Cortisol ([micro]g/dl) 38.4 16.9 14.1 Dehydroepiandrosterone-sulfate 482 (DHEA-s) ([micro]g/dL) Epinephrine (ng/ml) 0.332 0.015 Norepinephrine (ng/ml) 0.487 0.089 Dopamine (ng/ml) 0.027 0.012 Urine
metanephrine (ng/mg Cr) 328 119 Urine normetanephrine (ng/mg Cr) 63 176 Plasma renin activity (ng/mL/hr) 3.2 Aldosterone (pg/mL) 202.0 6 months ACTH (pg/mL) 1.9 Cortisol ([micro]g/dl) 6.7 Dehydroepiandrosterone-sulfate (DHEA-s) ([micro]g/dL) Epinephrine (ng/ml) Norepinephrine (ng/ml) Dopamine (ng/ml) Urine
metanephrine (ng/mg Cr) Urine normetanephrine (ng/mg Cr) Plasma renin activity (ng/mL/hr) Aldosterone (pg/mL) Table 2: Rapid ACTH test.
Adrenal incidentaloma, borderline elevations of urine or plasma
metanephrine levels and the "subclinical" pheochromocytoma.
Complete analysis (glucose, ureic acid, plasmatic proteins and ions), including 24-hour urine catecholamines (nor-metanephrine,
metanephrine and vanilmandelic acid), and tumour markers (carcinoembryonic antigen, carbohydrate antigen [Ca] 19.9, Ca 125, and [beta]-human chorionic gonadotropin) were normal.
This case illustrates well that some pheochromocytomas or paragangliomas (extraadrenal tumors) can indeed present with only mildly increased
metanephrine concentrations despite their large size.
(b) NMN, normetanephrine; MN,
metanephrine; MT, methoxytyramine; NE, norepinephrine; E, epinephrine; DA, dopamine; URL, upper reference limit.
Although many different biochemical tests have historically been used in screening for PPGL, measurements of the catecholamine breakdown products
metanephrine and normetanephrine in plasma and urine are now regarded as the first-line tests.