This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weise, M. Articles by Eisenhofer, G. Search for Related Content PubMed PubMed Citation Articles by Weise, M. Articles by Eisenhofer, G.

Utility of Plasma Free Metanephrines for Detecting Childhood Pheochromocytoma

Developmental Endocrinology Branch (M.W.), Pediatric and Reproductive Endocrinology Branch (D.P.M., K.P.), National Institute of Child Health and Human Development; Clinical Neurocardiology Section (G.E.), National Institute of Neurological Disorders and Stroke; Urologic Oncology Branch (M.M.W.), National Cancer Institute; and the Warren Grant Magnuson Clinical Center (D.P.M.), National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Graeme Eisenhofer, Ph.D., Building 10, Room 6N252, National Institutes of Health, 10 Center Drive, MSC 1620, Bethesda, Maryland 20892-1620. E-mail: . ge{at}box-g.nih.gov

Abstract

Measurements of plasma free metanephrines, normetanephrine (NMN) and metanephrine (MN), provide a sensitive test for diagnosis of pheochromocytoma in adults but have not been evaluated in children. We therefore established reference ranges for plasma and urinary metanephrines and the catecholamines, norepinephrine (NE) and epinephrine (E), in 86 healthy children (age 5–17). A group of 158 healthy adults (age 18–72) served as a comparison group. Pediatric reference ranges were applied to examine the diagnostic utility of the various tests in 45 children evaluated for pheochromocytoma (age 8–17; 38 with von Hippel-Lindau syndrome), with tumors found on 12 occasions. Upper reference limits for E and MN were higher and those for NE and NMN lower in children than in adults. Boys had higher plasma levels of E and MN and higher urinary excretion of all four amines than girls. Plasma free metanephrines provided a diagnostic test with values for sensitivity (100%) and specificity (94%) that were equal to or higher than those of other tests. In two children screened for pheochromocytoma on multiple occasions, use of pediatric reference ranges for plasma free metanephrines indicated the tumor a year earlier than indicated using adult reference ranges. The findings indicate that plasma free metanephrines provide a sensitive tool for detection of pheochromocytoma in children. Age appropriate reference ranges should be used and gender differences should be considered.

This article has been cited by other articles:

				W. Yuan, W. Wang, B. Cui, T. Su, Y. Ge, L. Jiang, W. Zhou, and G. Ning Overexpression of ERBB-2 was more frequently detected in malignant than benign pheochromocytomas by multiplex ligation-dependent probe amplification and immunohistochemistry Endocr. Relat. Cancer, March 1, 2008; 15(1): 343 - 350. [Abstract] [Full Text] [PDF]

				Y. B. Sverrisdottir, T. Mogren, J. Kataoka, P. O. Janson, and E. Stener-Victorin Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth? Am J Physiol Endocrinol Metab, March 1, 2008; 294(3): E576 - E581. [Abstract] [Full Text] [PDF]

				M. d'Herbomez, G. Forzy, C. Bauters, C. Tierny, P. Pigny, B. Carnaille, F. Pattou, J.-L. Wemeau, and N. Rouaix An analysis of the biochemical diagnosis of 66 pheochromocytomas Eur. J. Endocrinol., May 1, 2007; 156(5): 569 - 575. [Abstract] [Full Text] [PDF]

				J. Sullivan, T. Groshong, and J. D. Tobias Presenting Signs and Symptoms of Pheochromocytoma in Pediatric-aged Patients Clinical Pediatrics, October 1, 2005; 44(8): 715 - 719. [Abstract] [PDF]

				M. S. Lora, S. G. Waguespack, J. F. Moley, and E. C. Walvoord Adrenal Ganglioneuromas in Children with Multiple Endocrine Neoplasia Type 2: A Report of Two Cases J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4383 - 4387. [Abstract] [Full Text] [PDF]

				L. Jackson, F. L. R. Williams, A. Burchell, M. W. H. Coughtrie, and R. Hume Plasma Catecholamines and the Counterregulatory Responses to Hypoglycemia in Infants: A Critical Role for Epinephrine and Cortisol J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6251 - 6256. [Abstract] [Full Text] [PDF]

				S. A. Lagerstedt, D. J. O'Kane, and R. J. Singh Measurement of Plasma Free Metanephrine and Normetanephrine by Liquid Chromatography-Tandem Mass Spectrometry for Diagnosis of Pheochromocytoma Clin. Chem., March 1, 2004; 50(3): 603 - 611. [Abstract] [Full Text] [PDF]

				Y. C. Kudva, A. M. Sawka, and W. F. Young Jr. The Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4533 - 4539. [Full Text] [PDF]