Abstract | Objectives: Plasma free metanephrines are commonly used for diagnosis of pheochromocytoma and paraganglioma (PPGLs), but can also provide other information. This multicenter study prospectively examined whether tumor size, location, and mutations could be predicted by these metabolites. Methods: Results: Predictions of adrenal vs. extra-adrenal locations according to increased plasma concentrations of metanephrine and methoxytyramine were correct in 93 and 97% of the respective 136 and 33 patients in who these predictions were possible. Predicted mean tumor diameters correlated positively (p<0.0001) with measured diameters; predictions agreed well for pheochromocytomas but were overestimated for paragangliomas. Considering only patients with mutations, 51 of the 54 (94%) patients with NF1 or RET mutations were correctly predicted with those mutations according to increased plasma metanephrine, whereas no or minimal increase in metanephrine correctly predicted all 71 patients with either VHL or SDHx mutations; furthermore, among the latter group increases in methoxytyramine correctly predicted SDHx mutations in 93% of the 29 cases for this specific prediction. Conclusions: Extents and patterns of increased plasma O-methylated catecholamine metabolites among patients with PPGLs allow predictions of tumor size, adrenal vs. extra-adrenal locations and general types of mutations. Predictions of tumor location are, however, only possible for patients with clearly increased plasma methoxytyramine or metanephrine. Where possible or clinically relevant the predictions are potentially useful for subsequent clinical decision-making.
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Authors | Graeme Eisenhofer, Timo Deutschbein, Georgiana Constantinescu, Katharina Langton, Christina Pamporaki, Bruna Calsina, Maria Monteagudo, Mirko Peitzsch, Stephanie Fliedner, Henri J L M Timmers, Nicole Bechmann, Maria Fankhauser, Svenja Nölting, Felix Beuschlein, Anthony Stell, Martin Fassnacht, Aleksander Prejbisz, Jacques W M Lenders, Mercedes Robledo |
Journal | Clinical chemistry and laboratory medicine
(Clin Chem Lab Med)
Vol. 59
Issue 2
Pg. 353-363
(10 01 2020)
ISSN: 1437-4331 [Electronic] Germany |
PMID | 33001846
(Publication Type: Journal Article)
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Chemical References |
- Biomarkers, Tumor
- Normetanephrine
- Metanephrine
- 3-methoxytyramine
- Dopamine
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Topics |
- Adrenal Gland Neoplasms
(diagnosis)
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Biomarkers, Tumor
(blood)
- Dopamine
(analogs & derivatives, blood)
- Female
- Humans
- Male
- Metanephrine
(blood)
- Middle Aged
- Mutation
- Neurofibromatosis 1
(genetics)
- Normetanephrine
(blood)
- Paraganglioma
(diagnosis)
- Pheochromocytoma
(diagnosis)
- Prospective Studies
- Proto-Oncogenes
(genetics)
- Risk Factors
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