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Biochemical tests for pheochromocytoma: strategies in hypertensive patients
M J Young1, C Dmuchowski, J W Wallis
1Department of Internal Medicine, Medical College of Wisconsin, Milwaukee 53226.
Objective:
To determine the optimal clinical strategy utilizing either 1) serum catecholamines, 2) urinary metanephrines, or 3) urinary vanillylmandelic acid measurements in the evaluation of hypertensive patients with suspected pheochromocytoma.
Design:
Prospective clinical determination of test-operating characteristics.
Setting:
Tertiary care university medical center.
Patients/Participants:
415 patients referred for evaluation of suspected pheochromocytoma.
Interventions:
All subjects had measurements of the three above-mentioned biochemical tests with the diagnosis of pheochromocytoma established by tissue confirmation.
Results:
All three biochemical tests were similar in sensitivity (0.70-0.75), specificity (0.90-0.95), and receiver operating characteristics. With an estimated disease prevalence of 5.9% in symptomatic hypertensive patients, the predictive value of any single negative test would be 98% in ruling out disease.
Conclusions:
All three biochemical tests have similar performance characteristics and only a single test need be performed to exclude pheochromocytoma in most symptomatic hypertensive patients in a primary care population.