A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma

Anna M. Sawka, Ally P H Prebtani, Lehana Thabane, Amiram Gafni, Mitchell Levine, William Francis Young

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Abstract

Background: Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. Methods: We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. Results: Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%-100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%-100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07). Conclusion: Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.

Original languageEnglish (US)
Article number2
JournalBMC Endocrine Disorders
Volume4
DOIs
StatePublished - Jun 29 2004

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Metanephrine
Pheochromocytoma
Genetic Predisposition to Disease
Checklist
Databases

ASJC Scopus subject areas

  • Medicine(all)
  • Endocrinology, Diabetes and Metabolism

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A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma. / Sawka, Anna M.; Prebtani, Ally P H; Thabane, Lehana; Gafni, Amiram; Levine, Mitchell; Young, William Francis.

In: BMC Endocrine Disorders, Vol. 4, 2, 29.06.2004.

Research output: Contribution to journalArticle

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